부산대학교 도서관

Multiple myeloma is a cancer of plasma cells, a type of white blood cell present in bone marrow. Cytomegalovirus(CMV) is an important pathogen after allogeneic transplantation. However, few studies have examined CMV reactivation after autologous hematopoietic stem cell transplantation (AHSCT) to treat multiple myeloma(MM). Here, we present our case of CMV reactivation following AHSCT in MM with extramedullary plasmacytoma. 52-years-old female patient visited emergency room due to left arm pain. Her pain started 2weeks ago. Her pain aggravated after bumping to the wall. Serum protein electrophoresis showed peak in gamma region with 4.2g and bone marrow aspiration has 48.2% of immature plamsa cell. Initial serum free kappa light chain were 3,760mg/L. Chest PA showed pleura based plasmacytoma and multiple osteolytic lesion in left humerus and pathologic fracure in same bone. So, she was diagnosed lgG kappa tyep multiple myleoma. She received nail fixation operation in the left humerus. After surgery, she treated with four cycles of thalidomide, cyclophosphamide and dexamethasone(TCD). Her plasmacytoma and marrow plasmacytosis disappeared and serum immunofixation electrophoresis turned to negative. Patient completely recovered after transplantation. CMV Ag were detected on D17 after AHSCT, so intravenous ganciclovir started but CMV Ag copy number did not turned negative. Cidofovir were started after 12days treatment of ganciclovir because of CMV Ag were successively increased. CMV Ag turned to negative following two time injection of cidofovir. A retrospective single center paper reported CMV reactivation after AHSCT in MM and it is relatively common. CMV viremia was frequently detected in CMV seropositive patient. CMV surveillance should be considered, especially when tandem transplantation is performed using combination chemotherapy with highdose melphalan. This is not the case of tandem transplantation but CMV surveillance can be useful in clinical setting.