A 75-Year-Old Woman With Multiple Myeloma
Saad Usmani, MD, presents a case of 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
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