Toxicity Management in Patients with Transplant-Not Preferred NDMM

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).