CASE REPORT article
Front. Oncol.
Sec. Hematologic Malignancies
Fanconi Syndrome Developing and Worsening During Anti-myeloma therapy in Multiple Myeloma: A Case Report and Literature Review
Pengpeng Zhang 1
Peng li 2
Xinlian Zhang 1
Yang Xia 1
Yujuan Niu 1
Xin-guang Liu 2
Xuemei Qin 2
1. Second Clinical Medical College of Gansu University of Chinese Medicine·Lanzhou First People's Hospital, Lanzhou, China
2. Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Abstract
Background: Fanconi syndrome (FS) is a rare renal complication of monoclonal gammopathies including multiple myeloma (MM), typically diagnosed before or at the time of MM presentation. Onset and progression of FS during anti-myeloma treatment are extremely rare and easily misdiagnosed, resulting in delayed electrolyte correction and clinical deterioration. Case presentation: We report a 55-year-old woman with κ light chain MM who developed FS during induction therapy and experienced recurrence after autologous stem cell transplantation (ASCT). Initial workup showed subclinical tubular dysfunction with renal glycosuria and elevated tubular markers, which was initially overlooked. Shortly after induction therapy, she developed severe and recurrent hypokalemia and hypophosphatemia accompanied by progressive gastrointestinal symptoms despite hematological remission. A multidisciplinary consultation confirmed MM-associated FS. Electrolyte replacement, particularly phosphate supplementation, rapidly relieved her symptoms. With ongoing anti-myeloma therapy, glycosuria gradually resolved. Following ASCT, FS recurred but resolved with supportive care. The patient has remained in remission during continued follow-up. Conclusion: Anti-myeloma therapy may transiently induce or exacerbate FS, especially in patients with pre-existing renal tubular dysfunction, likely due to synergistic tubular toxicity of anti-myeloma agents. Early recognition, frequent electrolyte monitoring and prompt correction, as well as multidisciplinary collaboration, are crucial for optimal management of FS.
Summary
Keywords
Anti-myeloma therapy, Autologous hematopoietic stem cell transplantation, electrolyte replacement, Fanconi Syndrome, Multiple Myeloma
Received
30 October 2025
Accepted
20 February 2026
Copyright
© 2026 Zhang, li, Zhang, Xia, Niu, Liu and Qin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Xuemei Qin
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