Practice Support Cases

	Diagnosis, Staging, Risk Stratification, Prognosis and Response Assessment A 62-year-old man, presents to the ER with increasing fatigue, bone aches and back pain. Over the past six months, he has lost 20 pounds and complains of nausea and general malaise. He has a 10-year history of hypertension and poorly controlled type II diabetes which includes mild diabetic peripheral neuropathy for the past three years. He has been referred to an oncologist due to lab test findings at this ER visit. How would you stage this person? What diagnostic tests would you order? How would you treat this patient and what response could be expected?
	Newly Diagnosed, Transplant Eligible A 61-year-old woman with a history of high blood pressure that is well controlled and otherwise in good health is diagnosed with Stage II multiple myeloma after falling and suffering a vertebral compression fracture. How would you treat this patient? Would she be a good transplant candidate or would induction therapy with novel agents be preferable?
	Newly Diagnosed, Elderly, Non-transplant Patient A 79-year-old male with a history of well-controlled hypertension, hyperlipidemia, prostatic hypertrophy, and a 6-year-old coronary stent placement. He presents with five months of progressive fatigue, dyspnea, bony pains, anorexia and an ECOG performance status of 1. He is diagnosed with Stage III disease. What treatment would you use for this elderly patient? What side effects and toxicities would be of most concern?
	Relapsed/Refractory Disease Management A 44-year-old woman, diagnosed with ISS stage II multiple myeloma, was treated with four cycles of infusional vincristine and doxorubicin along with pulsed dexamethasone. After four cycles she had a stem cell transplant with high-dose melphalan and achieved complete remission. Her maintenance regimen included pamidronate and prednisone. Five years later, she is beginning to show signs of relapse. What treatment plan would you follow for this patient?
	Maintenance Therapy for Multiple Myeloma A 61-year-old woman is diagnosed with ISS stage II multiple myeloma after a vertebral compression fracture. She was treated with bortezomib, and after two cycles she achieved a partial response, but then the dose of bortezomib was decreased due to the occurrence of peripheral neuropathy, and after three cycles, the patient achieved an immunofixation-negative CR. Then she underwent stem cell collection for a possible autologous transplant. Do we give this patient the maintenance therapy and, if so, which and for how long should we give this treatment?
	The Multidisciplinary Team Approach: Managing the Newly Diagnosed Patient This is a 45-year-old who presents with kappa light chain myeloma. She has 5 grams of urine protein with Bence-Jones at around 3 grams. Her creatinine is 1.7, her beta-2 microglobulin is 4.7. She has no paraprotein peak in the blood, but her light chains are around 120,000, which gives her a very elevated kappa-lambda ratio. How should we treat this patient? What are her risk factors? Is she a candidate for transplant? What special consideration should we take in the patient based on her comorbidities and her disease characteristics?