Early-Line Treatment Selection for High-Risk Relapsed/Refractory Multiple Myeloma
An expert on multiple myeloma outlines key considerations for selecting early-line treatments for high-risk patients with relapsed/refractory multiple myeloma.
Case: A 70-Year-Old Man with Early Relapse Multiple Myeloma
Clinical Presentation:
- A 70-year-old man who was diagnosed 5 years ago with R-ISS stage 2/R2-ISS stage III lenalidomide refractory IgG-kappa multiple myeloma presents to his oncologist after two prior treatment regimens.
- Lives in a rural community
- PMH: hypertension controlled with lisinopril.
Prior Treatments:
- Patient received previous treatments with:
- D-VRd followed by ASCT with lenalidomide maintenance.
- Achieved VGPR, post-ASCT.
- Isa-Kd
- D-VRd followed by ASCT with lenalidomide maintenance.
Follow up and Clinical Workup at Relapse:
- Patient reports complaints of excessive fatigue and low back pain exacerbated by movement.
- Ca 10 mg/dL; SCr 2.9 mg/dL
- Hgb 6 g/dL; LDH 281 U/L; Albumin 3.4 g/dL
- Beta-2 microglobulin: 6 mg/dL
- BM Biopsy: 80% lambda light chain restricted.
- sIFE, IgG kappa present
- M protein 5 g/dL; sFLC kappa 240 mg/dL; sFLC lambda 2 mg/dL
- Kappa/Lambda ratio, 120
- FISH: amp 1q21+; t(14:16)
- Repeat Imaging:
- PET/CT scan showed multiple bone lesions in vertebrae without EMD.
- ECOG PS 0
- After discussion with his clinical team, the patient begins evaluations for CAR T referral.
- Patient ultimately proceeded to cilta-cel CAR T-cell infusion.
- Achieved stringent CR at day 30.
- Patient ultimately proceeded to cilta-cel CAR T-cell infusion.
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