Fig. 3

Whole clinical course of the patient. Regimen ➀ (VAD) was fairly effective for reducing free light chain. Levels of free light chain-λ were depressed to 1140 mg/L from more than 3200 mg/L. Afterwards, various combination chemotherapies were carried out; however, the responses to some regimens were insufficient or other regimens, including Dex, although effective, were inappropriate to continue the treatments due to aggravation of diabetes mellitus. Stringent complete response was achieved by initiation of regimen ⑪ (sdpBR^Md-CAM⁸⁰⁰). Levels of hemoglobin gradually elevated to a normal range, and platelet levels fluctuated within normal range. Faint blue areas indicate hospitalization. ① VAD; ② R^MdD; ③ R^MdD-CAM⁴⁰⁰; ④ sdp BD; ⑤ B^RedD; ⑥ PD; ⑦ sdp BD; ⑧ VAD; ⑨ sdp BD-CAM⁸⁰⁰; ⑩ sdp B-CAM⁸⁰⁰; ⑪ sdp BR^Md-CAM⁸⁰⁰; ⑫ sdpB^RedR^Md-CAM⁸⁰⁰. BD Bor-Dex, BM bone marrow, BR Bor-Revlimid (lenalidomide), CAM clarithromycin, FLC free light chain, Md minimized dose, NCC nucleated cell count, PC plasma cell, PD pomalidomide-Dex, red reduced dose, sdp short dosing-period, VAD vincristine, adriamycin, and Dex