The Role of Stem Cell Transplant in R/R Multiple Myeloma

Case: A 60-Year-Old Woman with Later Relapsed/Refractory Multiple Myeloma

Clinical Presentation:

• A 60-year-old woman who was previously diagnosed 3 years ago with R-ISS stage 2/R2-ISS stage III IgG-lambda multiple myeloma presents to his oncologist after two prior treatment regimens.
  • Lives in a rural community

Prior Treatments:

• Patient received previous treatments with:
  • D-VRd followed by ASCT with lenalidomide maintenance.
  • Elo-Pd

Follow up and Clinical Workup at Relapse:

• Ca 12.5 mg/dL; SCr 2.5 mg/dL
• Hgb 8.2 g/dL; LDH 290 U/L; Albumin 2.8 g/dL
• Beta-2 microglobulin: 6 mg/dL
• BM Biopsy: 65% lambda light chain restricted.
• sIFE, IgG lambda present
• M protein 5.2 g/dL; sFLC kappa 5 mg/dL; sFLC lambda 560 mg/dL
• Lambda/Kappa ratio, 112
• Repeat Imaging:
  • PET/CT scan showed no additional lesions.
• ECOG PS 1
• After discussion with his clinical team, the patient begins evaluations for CAR T referral.
  • Patient ultimately proceeded to ide-cel CAR T-cell infusuion.
    • Achieved stringent CR at day 30.

Video content above is prompted by the following:

• Please discuss the role of stem cell transplantation (SCT) in the management of patients with R/R multiple myeloma, particularly for those who have been previously exposed to daratumumab/lenalidomide.