Patient Profile: A 54-Year-Old Woman with Newly Diagnosed Multiple Myeloma

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EP: 1.Patient Profile: A 54-Year-Old Woman with Newly Diagnosed Multiple Myeloma

EP: 2.Overview of Results from the DETERMINATION Trial of RVd plus ASCT for Newly Diagnosed Multiple Myeloma

EP: 3.Discussion of Final Analysis of the GRIFFIN Study Comparing DARA+RVd versus RVd

EP: 4.Review of Primary Outcomes from the PERSEUS Trial of Subcutaneous DARA+VRd in Transplant-Eligible Newly Diagnosed Multiple Myeloma

EP: 5.Overview of the IsKia Trial Results Evaluating Isatuximab + KRd in Transplant-Eligible Newly Diagnosed Multiple Myeloma

EP: 6.Summary of Final Analysis from the MASTER Trial of DARA+KRd

EP: 7.Discussion of Phase 2 IFM 2018-04 Study Data Presented at 2023 ASH Examining DARA+VTd with Tandem ASCT for High Risk Transplant-Eligible Newly Diagnosed Multiple Myeloma

EP: 8.Key Clinical Insights for the Management of Newly Diagnosed Multiple Myeloma

Case: A 54-Year-Old Woman with Newly Diagnosed Multiple Myeloma (NDMM)

Clinical Presentation:

• FH is a 54-year-old woman who presents to her physician with complaints of back pain, fatigue, nausea, constipation, and occasional, but recurring dizziness

Initial Clinical Workup and Diagnosis:

• Hb 7.0 g/dL
• Calcium 11.3 mg/dL
• Creatinine, 1.5 mg/dL
• Albumin, 3.2 g/dL
• β2-microglobulin, 6.0 mg/dL
• LDH 200 U/L
• Bone marrow biopsy showed monoclonal plasma cells, 22%.
• Serum monoclonal protein, 5.0 g/dL
• Serum kappa FLC, 240.0 mg/L
• FISH: (+) IGH Translocations; none
• ECOG PS 1
• AG was diagnosed with R-ISS stage II/R2-ISS stage III IgG-kappa myeloma.
  • CAR T eligible

Treatment:

• Patient was initiated on daratumumab/bortezomib/ lenalidomide/ dexamethasone (D-VRd) induction therapy prior to receiving ASCT, followed by lenalidomide maintenance therapy.
  • She achieved VGPR post-induction, and
  • Maintained VGPR post-ASCT

This is a video synopsis/summary of a Case-Based Peer Perspectives featuring Douglas Sborov, MD.

Sborov discusses the case of FH, a 54-year-old woman who initially presented with back pain, fatigue, nausea, constipation, and occasional dizziness. Initial workup revealed profound anemia with hemoglobin of 7 g/dL, hypercalcemia with calcium of 11.3 mg/dL, creatinine of 1.5 mg/dL, albumin of 3.2 g/dL, β-2 microglobulin of 6 mg/L, and lactate dehydrogenase of 200 U/L. Bone marrow biopsy showed 22% monoclonal plasma cells. Serum protein electrophoresis showed an M spike of 5 g/dL. Involved κ light chains were 240 mg/L. Fluorescence in situ hybridization was negative for high-risk features. FH was diagnosed with Revised International Staging System (R-ISS) stage 2 IgG κ multiple myeloma and started on daratumumab, bortezomib, lenalidomide, and dexamethasone (DRVd) induction therapy, achieving a very good partial response (VGPR) before autologous stem cell transplant with melphalan 200 mg/m2.

Post transplant, FH retained a VGPR on lenalidomide maintenance. Sborov notes that although R-ISS stage 2 disease historically conferred a 5- to 7-year overall survival, available treatments such as chimeric antigen receptor T-cell therapy and bispecific antibodies are likely prolonging survival. Sustained minimal residual disease (MRD) negativity leads to better outcomes. While agreeing with the initial therapeutic approach, Sborov would have considered upfront autologous transplant even with low-level persistent disease, as the goal is deep MRD negativity in this young patient. However, balancing treatment intensity and secondary malignancy risk from early transplant exposure is warranted. Consolidation and doublet maintenance post transplant might have improved MRD negativity chances if they had been instituted. If a patient has a deep response, Sborov would continue lenalidomide over extended daratumumab exposure. He highlights debated issues such as optimal induction regimens and transplantation in the absence of survival data.

Video synopsis is AI-generated and reviewed by Targeted Oncology® editorial staff.