The RCd regimen (lenalidomide [LEN]-cyclophosphamide [CY]-dexamethasone [DEX]) was effective and well-tolerated in relapsed and refractory multiple myeloma (RRMM) European patients aged between 59 and 65 years. However, most Japanese myeloma patients are over 70 years old. Thus, we analyzed the safety of RCd therapy in a phase 1 study of elderly Japanese RRMM patients aged >70 years (median age 76 years). CY was administered to three cohorts of three patients each at 200, 300, and 400 mg on days 1, 8, and 15 of a 28-day cycle with DEX (40 mg on days 1, 8, 15, and 22) and LEN (15 mg on days 1–21) for a maximum 8 cycles. One patient receiving 200 mg CY developed thrombocytopenia (Gr.4) and pneumonia (Gr.3). Two patients each developed neutropenia (Gr.4) at 300 mg and skin rash (Gr.3) at 200 mg. No severe adverse events were observed. Maximum tolerated dose of CY was determined to be 400 mg. After 2 cycles, the overall response rate was 88.9%. After a median follow-up of 36.4 months, median duration of response, progression-free survival, and overall survival were 8.3, 10.6, and 36.4 months, respectively. (UMIN Clinical Trials Registry number, UMIN000009391).

A 67-year-old man presented with plasmacytomas in the hepatic portal region, as diagnosed with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Laboratory blood tests showed no myeloma-related symptoms such as hypercalcemia, renal failure, and anemia, and normal levels of serum immunoglobulins. However, bone marrow examination demonstrated approximately 15% of atypical plasma cells in bone marrow mononuclear cells, and serum tests showed an abnormal serum free light-chain ratio and monoclonal protein of Bence Jones lambda upon immunoelectrophoresis. Positron emission tomography/computed tomography demonstrated high ¹⁸F-fluorodeoxyglucose uptake in the portal hepatic tumors and several bone lesions accompanied by osteolysis. The patient was treated with bortezomib plus dexamethasone followed by high-dose melphalan with autologous stem cell transplantation, resulting in a complete response. Lymph nodes are common sites of extramedullary myeloma disease associated with poor prognosis. EUS-FNA is less invasive than open surgical biopsies and thus it is recommended in the differential diagnosis of plasmacytoma in cases such as ours. EUS-FNA may enable early treatment, resulting in a good response even in myeloma patients with unfavorable prognoses.

We developed an adherence support intervention using both counseling and a “patient medication notebook (Note),” which was provided by a certified nurse in cancer chemotherapy nursing (CN) and pharmacists for patients with multiple myeloma on ixazomib therapy. In the hospital, the CN provided counseling sessions to not only educate patients but also define objectives associated with their daily life. After discharge, pharmacies that share data about each patient and the customized objective using the “Note” supported adherence continuously. Nine patients suggested the intervention, including the median counseling sessions of 5 (3–7). By the second counseling session, we set a tailored goal for each patient. This intervention contributed to a grasp of adverse events (AEs), resulting in appropriate management. In patients who experienced AEs, their goal and mental support validation for anxiety by the CN resulted in continued motivation for treatment ixazomib. Furthermore, adherence support intervention could be feasible and effective for ixazomib-treated patients.