December 13, 2019


Case: 75-Year-Old Woman with Newly Diagnosed Multiple Myeloma

History and Presentation:

  • 75-year-old woman; diabetic on metformin, no history of coronary artery disease or other comorbidities
  • κ light chain multiple myeloma diagnosed November 2019
    • Durie-Salmon Stage IIIA, ISS Stage 2
    • Laboratory findings
      • Total proteinuria 5.82 g/day
      • Bence Jones protein (BJP) 3.6 g/day
      • Hypogammaglobulinemia
      • Albumin 3.9 g/dL
      • β2-microglobulin 4.7 mg/L
      • Creatinine 1.7 mg/dl
      • No paraprotein peak but kappa light chain 2000 with lambda light chain at 1
      • Kappa/lambda ratio=2000
  • Bone marrow biopsy
    • Cellularity 25% with 80% plasma cells
  • Cytogenetics 46, XX
  • FISH no abnormalities
  • Imaging
    • Skeletal survey: extensive lytic bone disease with healing fractures of left 7thand the 8thribs
    • MRI of the spine: multiple compression fractures
    • MRI of the pelvis: diffuse marrow infiltrative changes due to myeloma
  • Cytogenetics/FISH: no adverse cytogenetics
  • ECOG PS: 1
  • Patient was started on D-VRd