December 13, 2019


Case: 83-Year-Old Man With NDMM Ineligible for Transplant

History and Presentation:

  • 83-year-old man c/o back pain and fatigue
  • Cardiac stent placed 3 years ago; high blood pressure; BMI 32

Diagnostic Workup:

  • Laboratory findings
    • M-protein 3.8 g/dL
    • Hb 7.9 g/dL
    • LDH 290 IU/L
    • Albumin 3.9 g/dL
    • β2-microglobulin 4.25 mg/L
    • Creatinine 1.5 mg/dL
    • FLC kappa 134 mg/dL

  • Bone marrow biopsy
    • Good cellularity with 60% bone marrow plasma cells
  • Cytogenetics/FISH: standard-risk, no cytogenetic abnormalities
  • Imaging
    • MRI of the spine: multiple focal lesions; moderate diffuse infiltration of spine, pelvis, and proximal femurs.
  • ECOG PS: 2
  • Durie-Salmon PLUS Stage IIIA IgG multiple myeloma requiring treatment with symptomatic anemia and bone lesions

Treatment:

Patient was started on D-Rd