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case_images: The bone marrow aspiration. (a and b) The bone marrow is hyperplastic, with an increase in megakaryocytes. Cells at various stages of maturation in all three lineages are observed. No obvious atypical epithelial cells are noted. (c) There is an increase in plasma cells.
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case_images: Bone marrow examination showed a nucleated cell count of 8.5 x 104 micro/L (normal range: 10-25 x 104 micro/L), megakaryocyte count of 51.0 micro/L (normal range: 50.0-15.0 micro/L), plasma cells at 10.0% (normal range: 0.2-2.0%) (Figure 1), and megakaryocytes at 0.4% (normal range: 0-0.2%).
case_images: Bone scintigraphy (a) At the time of MM diagnosis. Abnormal accumulations are noted in the right sternum, left temporal bone, sternum, cervical-thoracic-lumbar-sacral vertebrae, left and right ilia, and right ischium. (b) After the completion of nine courses of DPd therapy. 1 year after the initiation of MM treatment. Although some residual accumulations are noted, the multiple abnormal accumulations observed previously have improved, suggesting that they were associated with pathological fractures caused by MM, rather than MM lesions themselves.
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case_images: Bone scintigraphy revealed heterogeneous abnormal uptake in the sternum, cervical-thoracic-lumbar-sacral vertebrae, left and right ilia, and right ischium, along with multiple uptakes in the left and right ribs (Figure 2). Furthermore, the accumulations in the ribs and spine observed in the bone scintigraphy before treatment were improved one year after the start of treatment, suggesting through clinical progression that they were associated with pathological fractures caused by MM, rather than MM lesions themselves (Figure 2).
case_images: Therapeutic course. (a) Created with September 9th, the start date of the first course of Bd therapy, as day 1. (b) Before DPd treatment, reticulocyte generally remained within the normal range of 0.7-2.3% (normal range: 0.8-2.0%), with no decline observed, and the IPF has consistently remained high. After DPd treatment, a decrease in IPF and an increase in platelet count were observed.
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case_images: This resulted in an improvement in IgA levels (Figure 3a), indicating a response to MM. In addition, following DPd therapy, a decrease in IPF and an increase in platelet count were observed, which eliminated the need for transfusions (Figure 3b).