MM-217: Successful Management of an Unusual Presentation of Multiple Myeloma without Transplantation

Abstract

>A 45-year-old male presented to the ER with fatigue and severe chest, scapula, and shoulder pain. The blood test showed anemia (Hb=6 g/dL) and hypercalcemia (Ca+=10.9 mg/dL). A bone Marrow biopsy was consistent with MM. A PET scan was done and showed diffuse large bone tissue. He was diagnosed with IgA kappa MM. Induction of chemotherapy with bortezomib 1.3 mg/m2, thalidomide 200 mg, steroids 4 mg, and zoledronic acid 4 mg IV was initiated with a very good partial response after 2 cycles, with regression of the bone lesions. The patient refused to have an autologous stem cell transplant (ASCT). He completed the VTD protocols, and he was maintained on thalidomide 100 mg/day, dexamethasone, and zoledronic acid. After 8 months of maintenance, noting that the patient was not compliant, a new PET scan showed massive bone lesions and tissue lesions progression. Bone marrow aspiration and biopsy with protein electrophoresis and immunofixation were performed, confirming disease relapse. After a thorough discussion with the patient, we decided to start second-line treatment with KRD, carfilzomib 20 mg/m2, REVLIMID 25 mg/day 1–21, and dexamethasone 40 mg. A subsequent evaluation of response by PET scan was performed after 2 cycles showed VGPR. The patient still refusing the ASCT due to financial reasons. He completed 6 cycles of KRD and remained under maintenance on REVLIMID.