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Case presentation

Case presentation. 56 years old man, usually healthy Controlled hypertension for 25 years (with no known end organ injury) Diabetes Mellitus – NID ~ 1.5 years (Diet only) For the last 2 months Increased weakness coughing. on admission.

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Case presentation

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  1. Case presentation • 56 years old man, usually healthy Controlled hypertension for 25 years (with no known end organ injury) Diabetes Mellitus – NID ~ 1.5 years (Diet only) • For the last 2 months • Increased weakness • coughing

  2. on admission • the patient was oliguric => anuric begun hemodialysis • X Chest ray : RLL Pneumonia • Bone survey : multiple/diffuse lytic lesions

  3. Laboratory Tests on admission • CBC : Hb – 7.7gr%; Plt – 108 x109/L; WBC – 4.9 x109/L • Biochemistry : Urea – 218mg%; Cr – 9.76 mg% • Albumin – 4.0 g% • LDH – 865 U/L • β2M – …./l • ESR – ../h • CRP – …..

  4. Laboratory Tests • PIEP + PIFE– Monoclonal spike of l light chain (IgG – 275 mg%; IgA – 28 mg%; IgM – 6 mg%) • FLC • k-FL–2.07 mg%(0.33-1.94) • l-FL – 1390 mg% (0.57-2.63) • k/lRatio – 0.001 (0.26-1.65) Bone marrow– aspiration – xx% plasma cells - biopsy –cellularity~ 80%; 50% atypical PC (monoclonal to k) • echo - good LV function, IVC - 1.3 cm, no signs of cardiac amyloidosis

  5. Diagnosis l-Light Chain Multiple Myeloma Stage IIIB (ISS III )

  6. Treatment options • HDD • HDD + Thalidomide • HDD + Bortezomib • HDD + Lenalidomide • HDD + Thalidomide + Brotezomib • VAD • CAD +/- Thalidomide +/- Brotezomib

  7. Course

  8. Treatment options • HDD • HDD + Thalidomide • HDD + Bortezomib • HDD + Lenalidomide • HDD + Thalidomide + Brotezomib • VAD • CAD +/- Thalidomide +/- Brotezomib

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