Background. We describe a case of lymphoplasmocytic lymphoma, refractory to conventional treatments and complicated with bone lesions and acute renal failure, completely regressed after therapy with bortezomib. Case report. Woman, 48 years old, in march 1994 receives diagnosis of lymphoplasmocytic lymphoma, refractory to conventional chemotherapy (chlorambucil, CHOP, fludarabine), immunotherapy (rituximab), radiotherapy. She comes to our attention in november 2005 for disease’s progression, associated to severe renal failure (sieric creatinine=3.65 mg/dl; creatinine clearance = 17.52 ml/min), caused by serious monoclonal proteinuria (21500 mg/24h). We decide to use dexamethazone (20 mg) and bortezomib at a reduced dose (1mg/m2 twice a week on days 1,4,8,11, for eight cycles). At the end of second cycle with bortezomib, there is a conspicuous reduction of proteinuria (350 mg/24h) with partial recovery of renal function (sieric creatinine = 1.7mg/dl; creatinine clearance=23.68ml/min) Because of severe neurologyc toxicity (convulsion, peripheric neuropathy) and appearance of herpetic lesions, we decide to suspend treatment with bortezomib. After eleven months from the end of treatment with bortezomib, PET total-body, shows only a moderate hypercaptation on the anterior segment of lower lobe of right lung. At a follow-up of 20 months renal function results clearly improved (sieric creatinine = 1.4 mg/dl; creatinine clearance=44.57 ml/min) with normalization of proteinuria (104 mg/24h).

Discussion. Renal faillure in course of lymphoplasmocytic lymphoma is a not frequent event. It is due to amount of paraprotein on endothelial side of glomerular basal membrane. Generally standard treatments not improves the renal failure. The therapeutic activity of the antiproteosome in myeloma and in different lymphomas is currently well documented (

O’Connor et al, JCO 2005, 23 (4):676–684
;
K. Anderson et al, JCO 2006 Annual Meeting Proceedings Part I. Vol 24 (18S): 7504
). Other authors have demonstrated the renal repair (
A. K. Malani et al, Acta Haematologica 2006;116 (4):255–258
).

Conclusion. bortezomib, proteosome inhibitor, can be used to improve not only myeloma and lymphoma course but also to repair renal failure, when caused by paraprotenemia/paraproteinuria.

Topics:
aftercare, bortezomib, kidney failure, lymphoma, creatinine, proteinuria, multiple myeloma, bone lesion, chemotherapy regimen, chlorambucil

Author notes

Disclosure: No relevant conflicts of interest to declare.

2007, The American Society of Hematology
2007
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