A 75-Year-Old Man With Multiple Myeloma

Case: A 75-Year-Old Man with Multiple Myeloma

Initial Presentation

• A 75-year-old man presents with worsening fatigue on exertion, pallor, and hip pain
• PMH: osteoarthritis
• PE: tired appearing male, poor hand-grip strength, mild tenderness on palpation of the left hip
• ECOG 2

Clinical workup

• Hb 9.8 g/dL, corrected calcium 11.9mg/dL, LDH 295U/L, creatinine 1.4mg/dL, albumin 3.7g/dL, CrCl 50mL/min
• Peripheral blood smear showed rouleaux formation
• Beta-2 microgloblulin 5.1 mcg/mL, M-protein 2.2 g/dL
• Lambda free light chains: 0.6 mg/dL, kappa free light chains: 14.3 mg/dL, ratio: 29 (k/l)
• FISH: hyperdiploid
• UPEP: M-spike of 400 mg of lambda light chains in 24 hours
• PET/CT revealed lytic bone lesions in the left hip
• Bone marrow biopsy shows 58% plasma cells IgG k
• Diagnosis: ISS and R-ISS, standard risk, stage II MM

Treatment

• Patient is ineligible for ASCT due to comorbidities
• Initiated treatment with daratumumab + bortezomib + melphalan + prednisone