Case 3: An Elderly Patient With Newly Diagnosed Myeloma

EXPERT PERSPECTIVE VIRTUAL TUMOR BOARD

Ola Landgren, MD, PhD:Let’s move on to the next case. This is an older patient with a new diagnosis of multiple myeloma, and I will ask Alfred to present this patient.

Alfred Garfall, MD:Sure. This is an 81-year-old man who visited her primary care physician for a routine physical. She complained of fatigue and confusion. She has a history of hypertension and high cholesterol that’s treated with atorvastatin and lisinopril, respectively.

Her evaluation showed severe anemia, with a hemoglobin [count] of 7.6 g/dL, hypercalcaemia [level] at 14.8 mg/dL, albumin of 3.3 g/dL, elevated beta-2-microglobulin of 6.9 mg/L, serum M-spike of 4 g/dL. Her CBC [complete blood count] showed a neutrophil count of 1400 and platelets of 155,000 mm³. Creatinine is 2.2 mg/dL, with a creatinine clearance of 38 mL/min. Her serum paraprotein that you mentioned—the serum M-spike was 4.7 g/dL. We see an IgA of 7200 [APL]. An x-ray showed osteopenia lytic lesions in the right forearm. An MRI [magnetic resonance imaging] scan showed diffuse abnormal bone marrow signal, and a bone marrow biopsy showed 60% plasma cells with t(11;14). So this is a patient with revised ISS [International Staging System] stage II disease by virtue of no high-risk cytogenetic abnormalities but still with elevated beta-2-microglobulin.

Transcript edited for clarity.