Patient Profile: A 70-Year-Old Man with Early Relapse Multiple Myeloma

Case: A 70-Year-Old Man with Early Relapse Multiple Myeloma

Clinical Presentation:

• A 70-year-old man who was diagnosed 5 years ago with R-ISS stage 2/R2-ISS stage III lenalidomide refractory IgG-kappa multiple myeloma presents to his oncologist after two prior treatment regimens.
  • Lives in a rural community
• PMH: hypertension controlled with lisinopril.

Prior Treatments:

• Patient received previous treatments with:
  • D-VRd followed by ASCT with lenalidomide maintenance.
    • Achieved VGPR, post-ASCT.
  • Isa-Kd

Follow up and Clinical Workup at Relapse:

• Patient reports complaints of excessive fatigue and low back pain exacerbated by movement.
• Ca 10 mg/dL; SCr 2.9 mg/dL
• Hgb 6 g/dL; LDH 281 U/L; Albumin 3.4 g/dL
• Beta-2 microglobulin: 6 mg/dL
• BM Biopsy: 80% lambda light chain restricted.
• sIFE, IgG kappa present
• M protein 5 g/dL; sFLC kappa 240 mg/dL; sFLC lambda 2 mg/dL
• Kappa/Lambda ratio, 120
• FISH: amp 1q21+; t(14:16)
• Repeat Imaging:
  • PET/CT scan showed multiple bone lesions in vertebrae without EMD.
• ECOG PS 0
• After discussion with his clinical team, the patient begins evaluations for CAR T referral.
  • Patient ultimately proceeded to cilta-cel CAR T-cell infusion.
    • Achieved stringent CR at day 30.