Management of Multiple Myeloma - Episode 1

Case 1: Optimal Induction Therapy for Myeloma

September 25, 2018

EXPERT PERSPECTIVE VIRTUAL TUMOR BOARDAjai Chari, MD:Thank you for joining us for thisTargeted Oncology Expert Perspective Virtual Tumor Board®, focused on multiple myeloma. Throughout this presentation, my colleagues and I will review strategies for managing 4 clinical cases based on recent evidence as demonstrated in clinical trials.

I’m Dr Ajai Chari. I’m an associate professor of medicine and the director of clinical research for the Multiple Myeloma Program at Mount Sinai Health System in New York, New York.

Also joining this discussion is: Dr C. Ola Landgren, a hematologist/oncologist and chief of the Myeloma Service at Memorial Sloan Kettering Cancer Center in New York, New York; Dr Pei Lin, a professor in the Department of Hematopathology at The University of Texas MD Anderson Cancer Center, in Houston, Texas; and Dr Nina Shah, an associate professor in the Department of Medicine at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, in San Francisco, California. Thank you for joining us. Let’s get started with our first case.

Here we have a 74-year-old Caucasian man who presented to his primary care physician complaining of fatigue. His only past medical history is osteoarthritis and associated limited mobility. His exam shows changes that are consistent with osteoarthritis in his joints, with poor grip strength and bilateral swelling in shoulder joints. But, he also has pallor. His blood work indicates anemia (with a hemoglobin of 10.2), hypercalcemia (12.9), and a slightly elevated creatinine (1.5 mg/dL), particularly considering his age. He was referred to hematology for further evaluation.

Notable lab findings include rouleaux on blood smear and a hemoglobin of 10.3. The creatinine improved slightly to 1.3, with a clearance of 61. The monoclonal protein is 1.4 g/dL with a free light chain of 4.43 mg/dL, confirming an IgG lambda phenotype. His LDH [lactic acid dehydrogenase] is 186, which is normal, and his beta-2 microglobulin elevated slightly—to 3.8. His bone marrow biopsy confirms the diagnosis of myeloma, with 43% plasma cells, and his FISH [fluorescence in situ hybridization] test shows t(14;16) translocation, making this a high-risk presentation. He has a good performance status. The patient was enrolled in a clinical trial of daratumumab with lenalidomide, bortezomib, and dexamethasone.

Transcript edited for clarity.