A 75-Year-Old Woman With Multiple Myeloma

Case: A 75-Year-Old Woman With Multiple Myeloma

Initial Presentation

• An active 75-year-old woman presented with new onset back pain and a 10-month history of fatigue, mild sensory neuropathy
• PMH: hypercholesterolemia, diabetes, and atrial fibrillation; all medically controlled
• PE: bony tenderness appreciated on the hips and lower back

Clinical Workup

• Labs: Hb 10.2 g/dL, calcium 11.1 mg/dL, LDH 186 U/L, creatinine 1.3 mg/dL, albumin 3.7 g/dL, beta-2 microgloblulin 3.6 mcg/mL, potassium 1100 g/dL, M-protein 2.6 g/dL, lambda free light chains 4.1 mg/dL
• Hepatitis B and C negative
• X-ray showed L4 vertebral compression fracture
• Skeletal survey showed multiple lytic lesions in femur
• Bone marrow shows 40% clonal plasma cells IgG k with hyperdiploidy FISH
• Diagnosis: R-ISS stage II MM
• ECOG 1

Treatment

• Patient is ineligible for ASCT due to comorbidities
• Initiated treatment with daratumumab + lenalidomide + dexamethasone