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.