Successful treatment with lenalidomide dexamethasone for second relapse of a patient with non-secretory multiple myeloma with extramedullary liver plasmacytomas: A case report

MM is defined as the presence of 10% of monoclonal plasma cells (PCs) in the bone marrow (or a biopsy-proven extramedullary plasmacytoma) along with endorgan damage due to the underlying disorder. For the majority of myeloma patients, plasma cells are restricted in the bone marrow. However, a small subgroup of patients might develop extramedullary myeloma (EMM), which is defined as the presence of clonal PCs outside the bone marrow. Magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET-CT) are the gold standard imaging techniques for the diagnosis, while biopsy of the lesion is highly recommended. The prognosis is very poor with a median overall survival that does not exceed 6 months. Patients with extramedullary disease are considered as high-risk patients and should be treated accordingly. In this case report we describe the management of a patient with nonsecretory myeloma who relapsed twice with extramedullary disease and we summarize the recommendations for therapeutic approaches of these patients that remain very challenging.