Roundtable Roundup: Early-Line Use of CAR T-cell Therapy in Multiple Myeloma

CASE SUMMARY

• A 60-year-old man who was diagnosed 3 years ago with lenalidomide-refractory IgG kappa multiple myeloma and translocation(14;16) presented to his oncologist at first relapse.
  • He lived in a rural community.
• Medical history: hypertension controlled with lisinopril
• He received previous treatments with:
  • D-VRd (daratumumab [Darzalex], bortezomib [Velcade], lenalidomide [Revlimid], and dexamethasone) followed by autologous stem cell transplant (ASCT) with lenalidomide maintenance
  • Achieved very good partial response post ASCT
• Patient complained of excessive fatigue and low back pain exacerbated by movement.
• ECOG performance status: 0
• Weight, 170 lb (down 15 lb in last 4 months)

Biopsy

• Bone marrow plasma cells: 20%

Laboratory results

• Calcium: 10 mg/dL
• Serum creatinine: 1.3 mg/dL
• Hemoglobin: 9.8 g/dL
• Creatinine clearance: 60 mL/min
• Serum-free light chain lambda: 0.2 mg/dL
• Serum-free light chain kappa: 24 mg/dL
• Kappa:lambda ratio: 120
• β2-microglobulin: 4 mg/dL
• Fluorescence in situ hybridization: amp 1q21+; t(14:16)
• M protein: 1.2 g/dL
• Serum immunofixation electrophoresis: IgG kappa present
• Albumin: 3.4 g/dL

Repeat imaging

• PET/CT: Showed multiple bone lesions in vertebrae without extramedullary disease