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

Opinion
Video

Sham Mailankody, MBBS, presents the case of a 70-year-old man with early relapse multiple myeloma and outlines clinical practices for identifying patients with high risk.

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.
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Sham Mailankody, MBBS, an expert on multiple myeloma
Sham Mailankody, MBBS, an expert on multiple myeloma
Sham Mailankody, MBBS, an expert on multiple myeloma
Sham Mailankody, MBBS, an expert on multiple myeloma
Sham Mailankody, MBBS, an expert on multiple myeloma
Sham Mailankody, MBBS, an expert on multiple myeloma
Sham Mailankody, MBBS, an expert on multiple myeloma
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