January 17, 2017

Case Scenario 1:

January 2015

  • The patient is a 61-year-old male who was diagnosed with ISS stage II MM.
  • Performance status 0.
  • At diagnosis bone marrow shows 40% light chain restricted plasma cells, FISH cytogenetics show hyperdiploid phenotype.
  • M-spike of 3.2 g/dL IgG kappa, serum free light chains kappa 60 mg/dL, lambda 1.5 mg/dL, ratio=40
  • Bloodwork show beta-2 microglobulin=4.2 mg/dL, Hg=8.2 g/dL, creatinine=0.9 mg/dL.
  • PET/CT shows multiple focal bone lesions in upper and lower extremities and in L2 and L3.Bone lesions have increased SUVs.
  • Based on these data and diagnosis of standard risk he was started on lenalidomide, bortezomib, and dexamethasone (RVD) induction.
  • He achieved a partial response with RVD.
  • He then had an autologous stem cell transplantation and achieved MRD negativity.
  • He was started on lenalidomide maintenance of 10 mg.

April 2016

  • Patient was experiencing back pain, loss of appetite and weight loss.
  • Blood work show beta-2 microglobulin=4.0 mg/dL, Hg=9 g/dL, creatinine=1.5 mg/dL.
  • M-spike is 0.5 g/dL, serum free light chains kappa 60 mg/dL, lambda 0.6 mg/dL, ratio=10.
  • Performance status 1.
  • Based on these criteria he was diagnosed with standard-risk multiple myeloma.
  • He was started on daratumumab, bortezomib, and dexamethasone.