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Imaging features of extramedullary, relapsed, and refractory multiple myeloma involving the liver across treatment with cyclophosphamide, lenalidomide, bortezomib, and dexamethasone.

A 55-year-old white woman presented in June 2003 with stage IIIA Durie-Salmon immunoglobulin (Ig) G κ multiple myeloma (MM) and was initially treated with thalidomide and dexamethasone followed by cyclophosphamide, with concurrent bisphosphonate (zoledronic acid), and intensified by autologous stem-cell transplant (ASCT) after high-dose melphalan conditioning. She remained in complete remission until December 2008, when she experienced relapse with occipital plasmacytoma and symptomatic extramedullary disease (EMD) arising from her skeleton. She was treated with an experimental second-generation proteasome inhibitor (NPI-0052, 0.7 mg/m2 administered intravenously [IV]), combined with low-dose weekly oral dexamethasone. She had evidence of clinical response (disease stabilization and symptomatic improvement). Treatment was completed after 6 months, and she declined maintenance options other than bisphosphonate.