A 78-Year-Old Man With Multiple Myeloma
Sagar Lonial, MD, FACP, presents a case of a 78-year-old man with multiple myeloma and discusses the many facets of treatment for multiple myeloma in the elderly population.
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
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