PMC3234033_01
LVEF over time. A normal LVEF by echocardiography was documented in April 2000 after two cycles of free doxorubicin and at the onset of Doxil/Caelyx. The patient had no signs and symptoms of cardiac disease until bortezomib was added to Doxil/Caelyx (February 2004) and simultaneously with a marked drop in IgA. The Doxil/Caelyx was discontinued and after medical management of hypertension and heart failure, the LVEF rose towards baseline in January 2006.
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Her IgA declined and remained stable at 1.9 g/dl for nearly 3 years (Figure 1). The left ventricular ejection fraction on transthoracic echocardiography was 30%, and Doxil/Caelyx was discontinued (Figure 1).
IgA and total protein over time in relation to treatments underwent by patient. The patient's IgA has been stable between 2000 and 3000 mg/dl since the addition of bortezomib in 2003. The total protein has been stable between 8.0 and 9.0 g/dl with treatment. Treatments are starred as following: *1 = melphalan and dexamethasone; *2 = carmustine and doxorubicin; *3 = pegylated liposomal doxorubicin; *4 = bortezomib; *5 = lenalidomide added to continued bortezomib.
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The patient's IgA has subsequently been stable at 2.2 g/dl in June 2008 on this combination, and her creatinine has returned towards normal (Figure 2).