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. 2022 Oct 19;6:73. doi: 10.1038/s41698-022-00315-2

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© The Author(s) 2022

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — Histopathologic findings in bone marrow biopsy at diagnosis showed extensive involvement by plasma cell myeloma. Neoplastic plasma cells were small and mature in appearance and present in a diffuse interstitial distribution comprising ~50–60% of overall marrow cellularity. Hematoxylin and eosin stain, ×400 magnification (a, left). Immunohistochemistry (IHC) for CD138 highlights neoplastic plasma cells present in abnormal clusters, ×400 magnification (a, middle). Fluorescence in situ hybridization (FISH) studies showed CCND1-IGH fusion in 95% of cells (yellow fusion signals indicated by arrow; a, right). Timeline of prior treatments and free light-chain response for Patient 1 (b, c), Patient 2 (d, e), Patient 3 (f, g) and Patient 4 (h, i). V bortezomib, C cyclophosphamide, D dexamethasone, R lenalidomide, P pomalidomide, K carfilzomib, HDC high dose cyclophosphamide, Dara daratumumab, Ven venetoclax, Sel selinexor, Ixa ixazomib, Elo elotuzumab, ACST autologous stem cell transplant, Benda bendamustine.