We report a case of a 78-year-old white male ( weight , 90 kg ) presented to the Department of Medical Oncology and Hematology , Istituto Clinico Humanitas , Rozzano , Milan , Italy , with refractory MM immunoglobulin G kappa ( IgGkappa ) , Durie-Salmon Stage IIA , with progressive renal failure after an oral melphalan , prednisone , and thalidomide regimen ( 4 mg/m2.d , 40 mg/m2.d for 7 days every 6 weeks , and 100 mg/d , respectively ) .
Bortezomib-dexamethasone combination in a patient with refractory multiple myeloma and impaired renal function. Multiple myeloma (MM) is a hematologic neoplasia characterized by the monoclonal proliferation of bone marrow plasma cells. Renal failure occurs in 20% to 30% of MM patients at diagnosis and in >50% with an advanced form of the disease. For those with advanced MM, often a high-risk group of patients with poor prognosis, salvage treatment for renal failure needs to avoid nephrotoxic drugs. ### Case Summary We report a case of a 78-year-old white male ( weight , 90 kg ) presented to the Department of Medical Oncology and Hematology , Istituto Clinico Humanitas , Rozzano , Milan , Italy , with refractory MM immunoglobulin G kappa ( IgGkappa ) , Durie-Salmon Stage IIA , with progressive renal failure after an oral melphalan , prednisone , and thalidomide regimen ( 4 mg/m2.d , 40 mg/m2.d for 7 days every 6 weeks , and 100 mg/d , respectively ) . The patient had documented increments of serum monoclonal component (M-protein), anemia, and renal failure with Bence Jones proteinuria (serum creatinine, 2.9 mg/dL; creatinine clearance, 30 mL/min; hemoglobin, 10.9 g/dL; serum IgGkappa M-protein, 3.9 g/dL; proteinuria 3.5 g/d;light-chain level in urine, 1.2 g/L). After 2 cycles with bortezomib at a reduced dose (1.0 mg/m2 twice weekly for 2 weeks followed by a 10-day rest period) to evaluate tolerability and renal toxicity, the patient completed another 3 cycles at the standard dose (1.3 mg/m2) in combination with dexamethasone (20 mg on the day of bortezomib administration and the day after). This led to an improvement of the renal function with a reduction of serum and urinary M-protein (serum creatinine 1.4 mg/dL; serum IgGkappa M-protein, 2.9 g/dL; proteinuria, 2 g/d; kappa light-chain level in urine, 0.7 g/L). The patient developed thrombocytopenia but did not suffer from some of the more severe adverse events associated with bortezomib, such as infection or peripheral neuropathy, even at full dose. ### conclusion We report an elderly patient with refractory MM and progression with renal failure who responded to bortezomib treatment. bortezomib was well tolerated in this patient.
### Instruction:
            Given the context about compound efficacy for the given treatment mentioned within the input, mentioned the compounds 
            that can co-occur for the mentioned treatment

            ### Input:
            Bortezomib-dexamethasone combination in a patient with refractory multiple myeloma and impaired renal function. Multiple myeloma (MM) is a hematologic neoplasia characterized by the monoclonal proliferation of bone marrow plasma cells. Renal failure occurs in 20% to 30% of MM patients at diagnosis and in >50% with an advanced form of the disease. For those with advanced MM, often a high-risk group of patients with poor prognosis, salvage treatment for renal failure needs to avoid nephrotoxic drugs. ### Case Summary We report a case of a 78-year-old white male ( weight , 90 kg ) presented to the Department of Medical Oncology and Hematology , Istituto Clinico Humanitas , Rozzano , Milan , Italy , with refractory MM immunoglobulin G kappa ( IgGkappa ) , Durie-Salmon Stage IIA , with progressive renal failure after an oral melphalan , prednisone , and thalidomide regimen ( 4 mg/m2.d , 40 mg/m2.d for 7 days every 6 weeks , and 100 mg/d , respectively ) . The patient had documented increments of serum monoclonal component (M-protein), anemia, and renal failure with Bence Jones proteinuria (serum creatinine, 2.9 mg/dL; creatinine clearance, 30 mL/min; hemoglobin, 10.9 g/dL; serum IgGkappa M-protein, 3.9 g/dL; proteinuria 3.5 g/d;light-chain level in urine, 1.2 g/L). After 2 cycles with bortezomib at a reduced dose (1.0 mg/m2 twice weekly for 2 weeks followed by a 10-day rest period) to evaluate tolerability and renal toxicity, the patient completed another 3 cycles at the standard dose (1.3 mg/m2) in combination with dexamethasone (20 mg on the day of bortezomib administration and the day after). This led to an improvement of the renal function with a reduction of serum and urinary M-protein (serum creatinine 1.4 mg/dL; serum IgGkappa M-protein, 2.9 g/dL; proteinuria, 2 g/d; kappa light-chain level in urine, 0.7 g/L). The patient developed thrombocytopenia but did not suffer from some of the more severe adverse events associated with bortezomib, such as infection or peripheral neuropathy, even at full dose. ### conclusion We report an elderly patient with refractory MM and progression with renal failure who responded to bortezomib treatment. bortezomib was well tolerated in this patient.

            ### Response:
            melphalan, prednisone, thalidomide
            