August 7, 2017

Multiple Myeloma in an Older Patient Who Develops Symptomatic Progression

December 2013

  • A 77-year old African American male was diagnosed 24 months ago with stage III multiple myeloma and was not eligible for transplant based on his level of frailty
  • His cytogenetics were classified as intermediate risk
  • He received treatment with lenalidomide (15 mg daily) and low-dose dexamethasone

December 2015

  • He reported feeling tired but continued to do well functionally
  • Laboratory findings:
    • Hb, 11.4 g/dL
    • Creatinine, 1.0 mg/dL
    • M-protein rose from 0.6 g/dl→1.2 g/dl→1.5 g/dl
  • Lenalidomide was increased to 25 mg daily; M-protein returned to normal

December 2016

  • The patient was hospitalized 2 months ago for pneumonia and now complains of increasing back pain, fatigue, and weakness
  • Laboratory findings:
    • M-protein, 2.1 g/dl
    • Serum beta-2-microglobulin, 6.2 mg/L
    • Albumin, 2.1 g/dL
    • Creatinine clearance of 32 ml/min
  • Skeletal survey shows new compression fracture in the L4/L5 vertebrae
  • Bone marrow biopsy shows 30% involvement by abnormal appearing plasma cells, confirmed by CD138+ IHC stain
  • Performance status, ECOG 2
  • The patient was treated with daratumumab, weekly subcutaneous bortezomib, and dexamethasone