The Future of NDMM: Ongoing Studies and Current Challenges in the Landscape


Melissa Alsina, MD cites recent data from ongoing studies as well as highlights remaining questions and unmet needs in the NDMM landscape.

Case: A 77-Year-Old Man with Transplant-Not Preferred Newly Diagnosed Multiple Myeloma (NDMM)

Patient KR is a 77 y/o man.

  • PMH: T2DM, hypertension, and COPD
  • SMH: Does not smoke; drinks occasionally in social settings.

Clinical Presentation:

  • In January 2023, KR visited his PCP for his annual checkup. He reported having persistent bone pain and increased fatigue.

Clinical Workup and Diagnosis:

  • Calcium 12.5 mg/dL
  • CrCl, 40 mL/min
  • Hgb, 9.8 g/dL
  • β-2 microglobulin, 7.8 mg/L
  • Albumin, 3.4 g/dL
  • LDH wnl
  • sFLC lambda at diagnosis, 1700 mg/L
  • Bone marrow showed 40% clonal plasma cells LLC restricted-Clonose Id obtained.
  • del(17p) abnormality detected by FISH.
  • PET-CT showed osteolytic lesions in several ribs; no extramedullary disease (EMD).
  • ECOG PS 2
  • IMWG Frailty Status: Intermediate-Frail
  • KR was diagnosed with ISS III/R-ISS stage III lambda LC multiple myeloma; determined to be transplant-not preferred based on age and comorbidities.

Current Treatment:

  • After discussions with his family and clinical team, KR was initiated on Daratumumab/lenalidomide/dexamethasone (D-Rd).
  • Patient achieved complete response (CR).
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