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Case: A 70-year-old man with early relapse of multiple myeloma

Clinical presentation:

• A 70-year-old man diagnosed with R-ISS stage 2 5 years ago/R2-ISS Stage III Lenalidomide-refractory IgG-kappa multiple myeloma presents himself to his oncologist after two previous treatment regimens.
  • Lives in a rural community
• PMH: Hypertension controlled with lisinopril.

Previous treatments:

• The patient previously received treatments with:
  • D-VRd followed by ASCT with Lenalidomide maintenance therapy.
    • VGPR achieved after ASCT.
  • Isa-Kd

Follow-up and clinical examination in case of relapse:

• The patient complains of excessive fatigue and lower back pain that worsens with movement.
• Approximately 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% of 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 the vertebrae without EMD.
• ECOG PS0
• After consultation with his clinical team, the patient begins the evaluation for referral for CAR-T therapy.
  • The patient eventually received a Cilta-Cel CAR-T cell infusion.
    • Strict CR was achieved on day 30.