A 77-Year-Old Woman With Multiple Myeloma

Rafael Fonseca, MD, discusses the case of a 77-year-old woman with multiple myeloma, treatment approach for patients with newly diagnosed multiple myeloma, and the trials providing insight into the treatment of this disease.

Case: A 77-Year-Old Woman with Multiple Myeloma

Initial Presentation

  • A 77-year-old woman presents with decreased appetites, fatigue, and back pain
  • PMH: unremarkable
  • PE: pain during ambulation, point tenderness on palpation of the mid-back
  • ECOG 1


Clinical Workup

  • Hb 9.2 g/dL, corrected calcium 11.8 mg/dL, LDH 285 U/L, creatinine 2.1 mg/dL, albumin 3.8 g/dL, CrCl 45 mL/min
  • Peripheral blood smear showed rouleaux formation
  • Beta-2 microgloblulin 4.2 mcg/mL, M-protein 2.5 g/dL
  • Lambda free light chains: 0.7 mg/dL, kappa free light chains: 13.3 mg/dL
  • FISH: hyperdiploid
  • UPEP: M-spike of 410 mg of lambda light chains in 24 hours
  • PET/CT revealed lytic bone lesions in at L2/L3
  • Bone marrow biopsy shows 60% plasma cells IgG k
  • Diagnosis: R-ISS stage II MM

Treatment

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