Expert Perspectives on a 75-Year-Old Woman With Triple-Class Refractory Multiple Myeloma

Case: A 75-Year-Old Woman with Triple-Class Refractory Multiple Myeloma

Initial Presentation

• A 75-year-old woman diagnosed with multiple myeloma 5 years ago returns to the clinic with complaints of extreme fatigue, increased muscle weakness and new bone pain in her right hip, right forearm and low back. She reports that she is currently taking antibiotics for a bacterial infection, her third in the last 12 months.
• Treatment history:
  • Initially treated with DRd; CR lasting 20 months
  • Switched to VRd, stable disease lasting 16 months
  • Subsequently switched to KPd, achieved a PR lasting 12 months
  • Started selinexor; follow up at 9 months showed M protein increase by 0.5 g/dl; patient continued to feel well 
• Currently, 3 months after her last visit, she returns to the clinic for follow-up
• PE: new bony tenderness appreciated on right hip, pelvis forearm and lumbar spine; bruising and mild bleeding of the gums

Clinical Workup

• Labs: Hb 6.2 g/dL, calcium 8.4 mg/dL, LDH 160 U/L, creatinine 2.1 mg/dL, albumin 2.7 g/dL, b2 microgloblulin 4.9 mcg/mL, serum M-protein 4.2 g/dL, lambda free light chains 4.1 mg/dL
• HBV negative
• Skeletal survey and MRI revealed lytic bone lesions in the left hip, pelvis and L2 vertebrae and lytic lesions as well as a hairline fracture in the distal radius of the right arm
• Bone marrow shows 62% plasma cells IgG k
• FISH: t(11;14) at diagnosis; new del(17p)
• Diagnosis: R-ISS stage II MM
• ECOG 1

Treatment

• Initiated treatment with belantamab mafodotin