A 79-Year-Old Woman With Multiple Myeloma
Clifton C. Mo, MD, provides insight on the management of multiple myeloma and evaluates the role of current treatment regimens.
Case: A 79-Year-Old Woman with Multiple Myeloma
Initial Presentation
- A 79-year-old woman presented with intermittent nausea, decreased appetite and tingling and numbness in her feet bilaterally
- PMH: HTN, medically controlled
- PE: thin, tired appearing woman, otherwise unremarkable; grade I peripheral neuropathy
- ECOG PS 0
Clinical Workup
- Labs: Hb 9.6 g/dL, calcium 10.5 mg/dL, LDH 210 U/L, creatinine 1.1 mg/dL, albumin 3.8 g/dL, beta-2 microglobulin 3.2 mcg/mL, M-protein 2.9 g/dL, serum free kappa light chains 4.4 mg/dL, CLCr 35mL/min
- Hepatitis B and C negative
- Skeletal survey and MRI showed a lytic lesion in her spine L3/L4
- Bone marrow shows 45% clonal plasma cells IgG k
- FISH: hyperdiploid
- Diagnosis: R-ISS stage I MM
Treatment
- Initiated lenalidomide + bortezomib + dexamethasone for 8 cycles + lenalidomide maintenance for 9 months
- Follow-up at that time revealed disease progression
- Initiated selinexor + bortezomib + dexamethasone
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