A 79-Year-Old Woman With Multiple Myeloma

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