Expert Perspectives on a 75-Year-Old Woman With Triple-Class Refractory Multiple Myeloma - Episode 1
Adriana Rossi, MD, presents the case of a 75-year-old woman with triple-class refractory multiple myeloma.
Adriana Rossi, MD: We have a case of a 75-year-old woman who was diagnosed with multiple myeloma 5 years ago, who is now coming back to clinic complaining of extreme fatigue, muscle weakness, and bony pain located in her hip and her forearm, as well as her low back. She mentions she’s taking antibiotics now for the third time in the past year for a recurring bacterial infection. Reviewing her chart, we see she initially received treatment with daratumumab, lenalidomide, and dexamethasone, and obtained a CR [complete response], which she maintained for 20 months. She was then switched to bortezomib, lenalidomide, and dexamethasone, and had stable disease this time for 16 months. And in her third line she started carfilzomib, pomalidomide and dexamethasone, achieving a partial response that lasted 12 months. Most recently, she was started on selinexor. She tolerated the treatment well for 9 months at which time her M protein was detected at 0.5 g/dL.
This was 3 months ago, so she has now been away from the clinic for 3 months, coming in with the above complaints, and on examination, indeed, she does have bony tenderness over the hip, the forearm and the low back, which are the areas that are hurting her. Clinical evaluations shows hemoglobin down to 6.2 g/dL, calcium of 8.4 mg/dL, LDH [lactate dehydrogenase] of 160 U/L. Her creatinine is 2.1 m/dL, albumin of 2.7 g/dL, and a beta-2 microglobulin of 4.9 μg/mL. Her M spike has risen to 4.2 g/dL, and her free light chains are up to 4.1 mg/dL. Skeletal survey and MRI show lytic lesions in the left hip, in the pelvis, L2 vertebrae, and a hairline fracture in the distal radius of the right arm. A bone marrow biopsy was completed and showed 62% plasma cells, which were kappa restricted. FISH [fluorescence in situ hybridization] showed the 11;14 translocation, which was present at the time of diagnosis, as well as a new deletion 17p. She’s been restaged as Revised-ISS [Revised International Staging System] stage II, and has an ECOG of 1. At that time, the decision was made to start treatment with belantamab.
Transcript edited for clarity.
Case: A 75-Year-Old Woman with Triple-Class Refractory Multiple Myeloma