A 75-Year-Old Man With Multiple Myeloma
A key opinion leader in hematology, Jonathan Kaufman, MD, provides insight into the case of a 75-year-old man with multiple myeloma and discusses treatment considerations, standard of care therapies, and recent clinical trial updates for the management of multiple myeloma.
Case: A 75-Year-Old Man with Multiple Myeloma
Initial Presentation
- A 75-year-old man presents with worsening fatigue on exertion, pallor, and hip pain
- PMH: osteoarthritis
- PE: tired appearing male, poor hand-grip strength, mild tenderness on palpation of the left hip
- ECOG 2
Clinical workup
- Hb 9.8 g/dL, corrected calcium 11.9mg/dL, LDH 295U/L, creatinine 1.4mg/dL, albumin 3.7g/dL, CrCl 50mL/min
- Peripheral blood smear showed rouleaux formation
- Beta-2 microgloblulin 5.1 mcg/mL, M-protein 2.2 g/dL
- Lambda free light chains: 0.6 mg/dL, kappa free light chains: 14.3 mg/dL, ratio: 29 (k/l)
- FISH: hyperdiploid
- UPEP: M-spike of 400 mg of lambda light chains in 24 hours
- PET/CT revealed lytic bone lesions in the left hip
- Bone marrow biopsy shows 58% plasma cells IgG k
- Diagnosis: ISS and R-ISS, standard risk, stage II MM
Treatment
- Patient is ineligible for ASCT due to comorbidities
- Initiated treatment with daratumumab + bortezomib + melphalan + prednisone
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