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Case Presentation: Myeloma Meeting Sheraton City Tower, Ramat Gan May 23, 2008

Case Presentation: Myeloma Meeting Sheraton City Tower, Ramat Gan May 23, 2008. Martin Ellis MD Hematology Institute Meir Medical Center. History & Physical. 48 y.o. male, Ashkenazi origin QC for Israel Aircraft Industries Referred 2 yrs ago for incidentally discovered hyperglobulinemia

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Case Presentation: Myeloma Meeting Sheraton City Tower, Ramat Gan May 23, 2008

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  1. Case Presentation: Myeloma MeetingSheraton City Tower, Ramat GanMay 23, 2008 Martin Ellis MD Hematology Institute Meir Medical Center

  2. History & Physical • 48 y.o. male, Ashkenazi origin • QC for Israel Aircraft Industries • Referred 2 yrs ago for incidentally discovered hyperglobulinemia • Asymptomatic • PE: NAD

  3. Laboratory findings • CBC – normal • Renal function, albumin, calcium – normal • Serum globulin – 6 g/dL • SPEP – peak in gammaglobulin region • IF: IgGλ • IQ: 4600 mg/dL • β2 microglobulin – 2.1 mg/dL • FLC ratio-0.09

  4. Marrow findings • 20% plasma cells, abnormal morphology • PCLI not done • Normal karyotype • FISH: del 13q in 43% of cells

  5. Imaging studies • Plain X rays (skeletal survey) - normal

  6. Clinical progress • After a year: • Shoulder and hip girdle pain • Tremor • CT of L. spine and hips: • Lytic lesions – T4, T5, T7, acetabular roof (large) • Concurrent diagnosis of HYPERTHYROIDISM • Tx with PTU • Reverted to asymptomatic state – maintained • Pamidronate started

  7. Laboratory progress • Gradual increase in monoclonal IgGλ: • 4660 mg/dL (6/06)  6820 mg/dL (4/08)

  8. Summary • Young patient • Asymptomatic • Active MM • Lytic lesions on CT (incidental) • Standard risk (mSMART) • BUT: Abnormal FLC ratio • BUT: clearly progressive-increasing IgG

  9. Questions for Dr Richardson • Treatment now or watch and wait and worry? • If treatment now: • Best std Tx (TDauto PBSCT) • Experimental protocol available at our center • RevDex  MPR vs autoPBSCT  Rev vs Observe

  10. Treatment options: • Auto PBSCT • TDauto PBSCT • Rev • Rev Dex • MPR

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