Isolated orbital relapse of multiple myeloma in a patient with severe chronic GVHD after allogeneic hematopoietic SCT

摘要

Allogeneic hematopoietic SCT (alloHSCT) is a potential curative treatment in multiple myeloma. However, relapse of multiple myeloma is still a major concern after alloHSCT. Whilst ocular involvement in chronic GVHD (cGVHD) is a frequent complication after alloHSCT, ocular involvement by multiple myeloma is rare. Here, we report a case of a 42-year-old male patient who presented with isolated orbital relapse of multiple myeloma during treatment of severe ocular cGVHD. He received alloHSCT from a gender- and HLA-matched sibling PBSC donor after conditioning with treosulfan and fludarabin as primary treatment for multiple myeloma (IgA-kappa) in partial remission after autologous HSCT in August 2007. Moderate cGVHD (initially overlap syndrome) with quiescent onset (prior steroid-sensitive acute GVHD grade 2) developed 8 months after alloHSCT involving the liver, gastrointestinal tract, oral mucosa and diffuse involvement of the fascia (predominately involving the trunk) that progressed 2 months later to moderate oral, severe cutaneous and severe bilateral ocular cGVHD with dry eye, pseudoptosis, blepharitis, persistent inflammatory activity of the conjunctiva and recurrent corneal erosions. Visual acuity was decreased due to corneal thinning and scarring after bilateral corneal ulceration. Ocular GVHD was treated topically with CYA 0.05% and steroid eye drops, unpreserved artificial tears and gels in addition to various systemic immunosuppressive medications including mycopheno-late mofetil, steroids, tacrolimus and extracorporeal photopher-esis. During immunosuppressive treatment the patient was stable for several months, but developed a painless subconjunctival redness and discrete swelling in the right eye 51 months after alloHSCT (Figure 1a).