Conclusion
Lytic bone lesions associated with non-Hodgkin’s lymphomas such as CLL
and WM/LPL are well-reported in the literature. However, the biology of
these bone lesions is poorly understood as is the optimal therapeutic
management of patients with lytic bone disease. Drugs such as
immunomodulatory agents, proteasome inhibitors, monoclonal antibodies,
and high dose melphalan followed by autologous stem cell transplant have
been extensively proven to reduce bone resorption in MM. Furthermore,
the addition of antiresorptive agents such as denosumab or ZA prevent
bone resorption and subsequent fractures in patients with MM. Many of
these agents have efficacy in WM/LPL yet their role in WM patients with
lytic bone lesions is unknown. Our case demonstrates the efficacy of the
chemoimmunotherapy regimen DRC in causing a complete response with
resolution of lytic bone lesions in a patient with LPL. Further research
is warranted on the ability of novel agents to reverse bone turnover in
WM/LPL patients as well as on the utility on antiresorptive agents in
non-Hodgkin’s lymphomas with lytic bone disease.