A 77-Year-Old Woman With Multiple Myeloma
Rafael Fonseca, MD, discusses the case of a 77-year-old woman with multiple myeloma, treatment approach for patients with newly diagnosed multiple myeloma, and the trials providing insight into the treatment of this disease.
Case: A 77-Year-Old Woman with Multiple Myeloma
Initial Presentation
- A 77-year-old woman presents with decreased appetites, fatigue, and back pain
- PMH: unremarkable
- PE: pain during ambulation, point tenderness on palpation of the mid-back
- ECOG 1
Clinical Workup
- Hb 9.2 g/dL, corrected calcium 11.8 mg/dL, LDH 285 U/L, creatinine 2.1 mg/dL, albumin 3.8 g/dL, CrCl 45 mL/min
- Peripheral blood smear showed rouleaux formation
- Beta-2 microgloblulin 4.2 mcg/mL, M-protein 2.5 g/dL
- Lambda free light chains: 0.7 mg/dL, kappa free light chains: 13.3 mg/dL
- FISH: hyperdiploid
- UPEP: M-spike of 410 mg of lambda light chains in 24 hours
- PET/CT revealed lytic bone lesions in at L2/L3
- Bone marrow biopsy shows 60% plasma cells IgG k
- Diagnosis: R-ISS stage II MM
Treatment
- Patient is ineligible for ASCT due to comorbidities
- Initiated treatment with daratumumab + bortezomib + lenalidomide + dexamethasone
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