Treatment of an elderly transplant ineligible patient with newly diagnosed myeloma

Dr. Ömür Gökmen Sevindik

Istanbul Medipol University
Palumbo A. Et. Al., Blood. 2015;125:2068, SEER Database 2021
Assessing Frailty

Engelhardt M et al. Haematologica. 2017; 102(5)

Frailty Indices
ESMO Guideline – Assessment of Frailty

Dimopoulos MA et al. Ann Oncol. 2021 Mar;32(3):309-322

ESMO Guideline – Assessment of Frailty

Dimopoulos MA et al. Ann Oncol. 2021 Mar;32(3):309-322

Frontline Treatment Options in Transplant Ineligible Myeloma Patients

Dimopoulos MA et al. Ann Oncol. 2021 Mar;32(3):309-322

VRd > Rd

Durie BGM et al. Lancet. 2017 Feb 4;389(10068):519-527

VRD - lite

O’Donnell E et al. Br J Haematol. 2018 Jul;182(2):222-230

Dara – VMP > VMP

Mateos MV et al. Lancet. 2020 Jan 11;395(10218):132-141

Dara – Rd > Rd

Facon T et al. N Engl J Med. 2019 May 30;380(22):2104-2115, Facon T et al. EHA2021; Abstract LB1901
Courtesy of J San Miguel
74 yr-old male

Heavy Smoker, COPD, Hypertension, type 2DM (Mod. Diabetic Neuropathy),

CKD (eGFR 48 ml/min/m2), has a brother dx with MM 2 yr ago

Fatigue, shortness of breath, productive cough

Hb: 8.4 g/dL, WBC: 6700/mm3, Plt: 83000/mm3

Cre: 1.39 mg/dl, Ca: 9.67 mg/dl, LDH: 192 u/l, Alb: 4.43 g/dl, B2 MG: 8.85
mg/l, M Prot: 2.5 g/dl, FLCr: 23.2 (l/k) 24 h Urine M prot: 240 mg/d

PET Scan: Multiple fdg avid (SUVmax: 4-6)

lytic lesions throughout the axial skeleton
and one at thalar region prone to a fracture risk
(2.8*2.7 cm) DRd initiated with no dose modification regarding Dara, Lenalidomide
was initiated with a dose of 10 mg/day and dexamethasone with a dose
BM Asp/Bx: 80 % CD138 positive lambda of 20 mg/day D 1,8 and 15
restricted clonal PCs
Was able to achieve a VGPR with 2 cycles of DRd, just experiencing an
Cytogenetics (iFISH): del17p (60%)
episode of pneumonia requiring short term hospitalization
Dx with IgA lambda R-ISS 3 MM with an R-MCI of 6
Planned to be operated among the thalar lytic lesion
Dimopoulos MA et al. Ann Oncol. 2021 Mar;32(3):309-322, Sevindik OG et al. TSH Myeloma Guideline ISBN: 978-605-80353-4-8 Mar 2020
Thank you..