Sustained ventricular tachycardia in a thalidomide-treated patient with primary plasma-cell leukemia

Background: A 68-year-old man diagnosed with primary plasma-cell leukemia was given thalidomide maintenance treatment for his disease. He had previously failed induction therapy with cyclophosphamide, vincristine, adriamycin, and dexamethasone, but achieved complete remission after melphalan therapy. Multiple syncopal episodes started to occur during thalidomide treatment, and a Holter electrocardiogram showed multiple abnormalities, with an episode of sustained ventricular tachycardia. Investigations: Blood tests, peripheral blood smear, bone-marrow biopsy and aspirate, Holter electrocardiogram. Diagnosis: Sustained ventricular tachycardia possibly owing to thalidomide treatment. Management: Thalidomide withdrawal, dexamethasone maintenance therapy, monthly oral courses of combined melphalan and prednisone, salvage therapy with bortezomib.