Multiple Myeloma: a case report into total remission for 13 years

M.D. Luciano Amati - A case of advanced Multiple Myeloma treated with Di Bella Method (DBM) into total remission for 13 years.

Summary

• Male patient 38 years old;
• Absence of relevant pathologies;
• In 1986, when 20 years old suffered of a contusion to the left tibia (shinbone) with local tumefaction. Onset of worsening tibial pain;
• August 1988: biopsy of the tumefaction led to a diagnosis of myeloma;

September 1988

X-ray scan revealed numerous and coarse bone erosions without periosteal reaction.

• Large lytic and destructive area [...], disappearance cortex for the length of 8 cm (see Figure1 below);
• Destruction and nearly total disappearance of the right ischial branch (see Figure2 below);
• Erosive lesion with definite margins at the left humerus (see Figure3 below);
• Complete destruction of the axillary arch, VI left rib, noticeable thickening of soft tissues [...] (see Figure4 below);
• The spinal column is undamaged from focal pathology (see Figure5 below);

Fig.1 - Large lytic and destructive area [...], disappearance cortex for the length of 8 cm.

Figure1

Fig.2 - Destruction and nearly total disappearance of the right ischial branch.

Figure2

Fig.3 - Erosive lesion with definite margins at the left humerus.

Figure3

Fig.4 - Complete destruction of the axillary arch, VI left rib, noticeable thickening of soft tissues.

Figure4

Fig.5 - The spinal column is undamaged from focal pathology.

Figure5

October 1988

Hospitalisation at the institute of Clinical Medicine (VI) University La Sapienza, Rome:

• Six radiotherapy sessions focused on the shinbone;
• A single chemotherapy session: Prednisone (Brand names Cortan, Deltasone, Prednisolone and so on - Side effects) and Melphalan (Trade name Alkeran - Side effects);
• The patient refused to undertake the subsequent sessions;
• After discharge the patient did not undertake any medical examination or therapy.

June 1989

Worsening of the spinal column pain and bilateral paraesthesia to the legs.

September 1989

Sudden appearance of plegia with urinary incontinence.

• Emergency hospitalisation at the haematology department at the Hospital S.Croce in Cuneo (Italy);
• Diagnosis: paraparesis from downfall of D10, Myeloma stage III A;
• Neurosurgery treatment proposed and refused for fear of being transfused (religious reasons);
• Urgently transferred at the Clinic Saint George in Nice (France), where medullary decompression is practised. The plegia does not regress but the lesion result stabilised;
• The patient undertakes a single session of chemotherapy with Methylprednisolone (Trade/Brand names Medrol, Medrone, Urbason, Medrate, Metilbetasone, Dopomedrol, Medesone, Mesopren, Metastab and so on - Side effects), Cyclophosphamide (Trade/Brand names Procytox, Neosar, Cyclophosphane, Cytophosphan, Cyclostin, Sendoxan, Clafen, Endoxan and so on - Side effects) and Doxorubicin (Trade/Brand names Doxil, Adriablastin, Adriblastin, Doxorubicine, Rubex, Doxorubicinum, Myocet and so on - Side effects);
• Worried form the side effects, the patient decides to not continue the chemotherapy;
• The parents talk with Prof. Di Bella Luigi.

19 - September - 1989

Figure6

19 - September - 1989

Figure7

27 - September - 1989

Figure8

October 1989

The 20th of October 1989 begins the therapy at home.

• Practicing the Di Bella multitherapy a gradual improvement of the general conditions and autonomy is observed;
• Gets married, gets the driving licence for disables, manages to work even if bounded to the wheelchair;
• The pathological monoclonal component is attenuated until it disappears.

1 - August - 1990

Figure9

In February 1990 the monoclonal component reappears and in January 1991 it becomes markedly prominent (see below). Spine pain develops.

February 1991

In February 1991 is hospitalised again at the Clinic Saint George in Nice (France).

• Decompressive laminectomy is practised at D7 level, abscission of neoplastic tissue;
• Diagnosis: multiple plasmacytoma with vertebral localisation.
• In-surgery radiotherapy as palliative was practised at the Hospital S.Croce in Cuneo on D5, D6, D7 and D8;
• A second session on the left shoulder blade and left costal arch.

Monoclonal component - 16/January/1991

Figure10

Monoclonal component - 29/January/1991

Figure11

Monoclonal component - 4/March/1991

Figure12

From October 1991 the pathological monoclonal band result reduced until it disappears and not more appeared (April 2004).

21 - August - 1992

Figure13

Monoclonal component - 8/October/1992

Figure14

23/January/1996

Figure15

Monoclonal component - 7/May/1997

Figure16

Considerations

It is a case of multiple myeloma in advanced phase at the time of the diagnosis.

The case was documented in three highly qualified hospitals. Complete documentation is available. The therapy followed is known in details.

Cytostatic treatment

• October 1988 - Clinical Medicine (VI) University La Sapienza, Rome (Italy): Prednisone 80 mg/day for 7 days (Brand names Cortan, Deltasone, Prednisolone and so on - Side effects) and Melphalan 10 mg/day for 5 days (Trade name Alkeran - Side effects);
• September 1989 - Clinic Saint George in Nice (France): Methylprednisolone 80 mg/day for 5 days (Trade/Brand names Medrol, Medrone, Urbason, Medrate, Metilbetasone, Dopomedrol, Medesone, Mesopren, Metastab and so on - Side effects), Cyclophosphamide 600 mg/day for 3 days (Trade/Brand names Procytox, Neosar, Cyclophosphane, Cytophosphan, Cyclostin, Sendoxan, Clafen, Endoxan and so on - Side effects) and Doxorubicin 45 mg/day for 2gg (Trade/Brand names Doxil, Adriablastin, Adriblastin, Doxorubicine, Rubex, Doxorubicinum, Myocet and so on - Side effects);

In both cases only a single session was performed.

Radiotherapy treatments

• October 1988 - Clinical Medicine (VI) University La Sapienza, Rome (Italy): Radiotherapy focused on the left shinbone. Total dose 24Gy;
• March 1991 - Hospital S.Croce in Cuneo (Italy): External beam radiotherapy (teletherapy) with high-energy photons was directed at the spine as palliative. Total dose 30 Gy;
• September 1991 - Hospital S.Croce in Cuneo (Italy): Paliative treatment in the left shoulder plate and left costal arch.

Di Bella Multitherapy

• Retinoids solution: Alpha Tocopheryl Acetate 1,000 gr - ATRA 0.5 gr - Axerophthol palmitate (Vitamin A palmitate) 0.5 gr - Betacarotene 2 gr;
• Dihydrotachysterol (Atiten®): 8 drops;
• Cyclophosphamide (Endoxan®): 50 mg, 1 tablet 3 times/day reduced to 1 table/day in 6 months;
• Somatostatin: 3mg/day;
• Melatonin (tablets, Prof. Di Bella’s formulation, chemically complexed as follows: Melatonin 12% - Adenosine 51% - Glycin 37%): 20mg/day;
• Clodronate (e.g. Clasteon, Difosfonal, Osteostab and so on): 400 mg 3 times/day;
• Soluble Synacthen® in alternate days;
• Potassium Chloride 5%: 30 drops 3 times/day;
• Bromocriptine (Trade name Parlodel): 2.5 mg 1 tablet/day;
• Calcium Carbonate - cholecalciferol (Calcidon®): 2/day.

The therapy was gradually reduced. From the end of 1992 he suspended the cyclophosphamide and the somatostatin. Currently the therapy consists in:

• Retinoids solution: Alpha Tocopheryl Acetate 1,000 gr - ATRA 0.5 gr - Axerophthol palmitate (Vitamin A palmitate) 0.5 gr - Betacarotene 2 gr;
• Dihydrotachysterol (Atiten®): 8 drops;
• Potassium Chloride 5%: 30 drops 2 times/day;
• Clodronate (e.g. Clasteon, Difosfonal, Osteostab and so on): 400 mg 3 tablet/day;
• Melatonin (tablets, Prof. Di Bella’s formulation, chemically complexed as follows: Melatonin 12% - Adenosine 51% - Glycin 37%): 6mg/day;
• Bromocriptine (Trade name Parlodel): 2.5 mg 1/2 tablet/week;

Conclusions

From 13 years any sign of the disease vanished so that is reasonable to think to a complete recovery.

The association of DBM and Radiotherapy directed on the most affected areas was able to eradicate the disease.

Translated by: Angelo Bella