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Multiple Myeloma Case Studies

Case Studies: Treatment of Multiple Myeloma with High-Risk Cytogenetics

Robert A. Vescio, MD, describes the case and treatment of a 55-year old female diagnosed with multiple myeloma with high-risk cytogenetics.

Treatment of Multiple Myeloma with High-Risk Cytogenetics

A 55-year-old African-American Woman With Relapsed Multiple Myeloma

August 2015

  • A 55-year-old African-American woman presented to her PCP complaining of worsening fatigue, back pain, and bone pain
  • PMH: hypertension managed on a beta blocker, mild renal impairment
  • Laboratory results:
    • Hb, 11.0 g/dL;
    • Ca2+, 10.1 mg/dL;
    • Creatinine, 1.2 mg/dL;
    • M-protein, 0.9 g/dL
    • Β2M, 5.0 mg/L
    • Albumin, 2.9 g/dL
  • MRI showed multiple small lytic lesions in the T1/T2 vertebrae
  • Bone marrow biopsy confirmed the diagnosis of multiple myeloma; R-ISS stage II; t(4;14)
  • She was treated with lenalidomide/bortezomib/dexamethasone (RVd) for 6 months and achieved a VGPR
  • The patient was recommended for autologous transplant, however, she instead opted to continue on a de-escalated treatment regimen of Rd after stating that she struggled to maintain her treatment schedule

May 2018

  • M-protein, May 1.5 g/dL

June 2018

  • M-protein, 1.7 g/dL

July 2018

  • MRI, no new lytic skeletal lesions
  • Laboratory results:
    • Hb, 11.5 g/dL;
    • Ca2+, 9.8 mg/dL;
    • Creatinine, 1.1 mg/dL;
    • M-protein, 1.9 g/dL
    • Β2M, 4.2 mg/L
  • ECOG PS: 0
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