Case 1: 51-Year-Old Man With Standard-Risk Myeloma

EXPERT PERSPECTIVE VIRTUAL TUMOR BOARD

Ola Landgren, MD, PhD:Thank you for joining us for thisTargeted Oncology™ Virtual Tumor Board®, which is focused on multiple myeloma. In today’sTargeted Oncology™ Virtual Tumor Board® presentation, my colleagues and I will review 4 clinical cases. We will discuss an individualized approach to treatments for each patient and will review key trial data that impact our decisions. I’m Dr Ola Landgren. I’m a professor of medicine and the chief attending physician for the myeloma service at Memorial Sloan Kettering Cancer Center in New York, New York.

Joining me today are Dr Ajai Chari, an associate professor of medicine and the director of clinical research in the multiple myeloma program at [the Icahn School of Medicine at] Mount Sinai, also in New York, New York; Dr Alfred Garfall, an assistant professor of medicine at the [Hospital at the] University of Pennsylvania in Pennsylvania; and Dr Nina Shah, an associate professor in the department of medicine at the [Helen Diller Family Comprehensive Cancer Center at the] University of California, San Francisco.

Thank you for joining us. Let’s get started with our first case.

Nina Shah, MD:The first case involves a newly diagnosed myeloma patient. In this case, a 51-year-old man presents with worsening fatigue, dyspnea on exertion, and pallor. Notable in his lab is a hemoglobin count of 9.2 g/dL, which is low. Otherwise, his creatinine and calcium are normal. The creatinine clearance was normal. The LDH [lactate dehydrogenase] was also normal. But the beta-2-microglobulin was elevated at 4.1 mg/L, with an albumin also a little low—at 3.2 mg/dL. Myeloma markers showed an M protein of 1.5 g/dL, and the lambda free light chain ratio was elevated at 110. Eventually, the patient had a bone marrow biopsy done, and this showed 66% involvement by plasma cells. On further analysis, a FISH [fluorescence in situ hybridization] showed a deletion of 13q.

The patient ultimately had a PET/CT [positron emission tomography/computed tomography], and this showed lytic lesions with an increased SUV [standardized uptake value]. This was shown in the ribs, as well as the bilateral femur, and pelvis. A UPEP [urine protein electrophoresis] was done, and this showed an M spike of 400 mg of lambda light chains in 24 hours. The IFE [immunofixation electrophoresis] was positive in the urine for IgG. The patient does have adequate liver and heart function, and because of his fatigue, he was deemed to have an ECOG performance status of 1. Overall, the diagnosis is consistent with multiple myeloma, standard-risk, but it is ISS [International Staging System] and revised ISS stage II, owing to the elevated beta-2-microglobulin and low albumin of 3.2 mg/dL.

Transcript edited for clarity.