A 78-Year-Old Man With Multiple Myeloma

Case: A 78-Year-Old Man with Multiple Myeloma

Initial Presentation

• An active 78-year-old man presents with a year history of progressive fatigue; he feels joint and muscle pain diffusely for about 2 months
• PMH: suffered a myocardial infarction 4 years ago; LVEF 45%
• PE: bony tenderness appreciated on the hips and lower back

Clinical Workup

• Labs: Hb 10.9 g/dL, calcium 10.0 mg/dL, LDH 160 U/L, creatinine 2.1 mg/dL, albumin 3.3 g/dL, beta-2 microgloblulin 5.2 mcg/mL, M-protein 2.6 g/dL, lambda free light chains 4.1 mg/dL
• Hepatitis B negative
• Skeletal survey and MRI revealed lytic bone lesions in the left hip, pelvis and L2 vertebrae
• Bone marrow shows 70% plasma cells IgG k restricted
• FISH: normal
• Diagnosis: R-ISS stage II MM
• ECOG 0

Treatment

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