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Patient Presentation I.M . (05/2008)

A 50-year-old male salesman presented with symptoms including weakness, weight loss, generalized bone pain, and night sweats for two months. His medical history was unremarkable, with a family history of lung cancer. Laboratory findings showed elevated ESR, significant anemia, and an M-spike of 7.16 g/dl, leading to a diagnosis of multiple myeloma (MM) with type IgG-k. His treatment plan included various chemotherapy regimens, supportive therapies, and options for stem cell transplantation. The patient's course included severe complications requiring extensive hospitalization.

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Patient Presentation I.M . (05/2008)

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  1. Patient Presentation I.M.(05/2008) Moshe Mittelman

  2. Pt IM – Presentation (11/2007) • A 50 yo, male, salesman • Present Illness: • Weakness, weight loss, generalized bone pain (back), night sweats (2m) • PMH: unremarkable (smoking) • Family: Lung Ca (father) • PE: Unremarkable

  3. Pt IM – Lab (11/2007) • ESR > 100 • CBC: Hb 10.6, Hct 31, MCV 94 • Chemist: TP 12.6, Glob 8.9, Up 396mg • Normal Cr, Ca • Proteins: • IgG 82 ! IgM 0.2, IgA< 0.2 • M-spike: 7.16 g/dl !!!

  4. Pt IM – Workup (11/2007) • M-spike (7.16 g/dl) - K • BM: 80% PC • X-ray: numerous lytic lesions • C2 (impending), C5, L2 • Ileum • Most ribs • Rt humerous

  5. Pt IM: Dg & Plan • Dg: MM – IgG-k • Plan: • Thal – Dexa • SCT (1-2) • RT • Supportive Rx • Pamidronate • Erythropoietin

  6. Pt IM: Rx • Thal-Dexa (poor Thal tolerance) • RT (C1-C7 3000r; D12-S1 3000r) • Supportive Rx: • RBC (x10u), rhuEPO • Pamidronate • Enoxaparin • Analgesics & Narcotics (Fentanyl 250) • Omeprazole, Cipralex

  7. Pt IM: Course - Compl (11/07-04/08) • Pain, Immobile; Wheelchair • Pneumoc. Pneumonia (ICU, ventilation) • Empyema, drainage • Thal intolerance (100-200), dec counts • Steroid withdrawal • Long hospitalization • Rehabilitation (partially successful)

  8. Pt IM: Rx Results (05/08)

  9. Pt IM: What now (05/08) ? • Do we (K)now ? • Options: • SCT ? (x1 ? x2 ?) • Velcade (?) • +/ Steroids ? Thalidomide ? • Lenalidomide ? (+ ??) • Supportive Rx only ? • Allo SCT (mini-allo) ?

  10. Pt IM: What now (05/08) ? Options: • SCT • Velcade +/- Steroids +/- Thalidomide • Lenalidomide +/- ?? • Supportive Rx only • Allo SCT (mini-allo)

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