Case Presentation: Clinical Decision Making in a R/R MM patient


Caitlin Costello, MD, discusses her insights and considerations when choosing the next line of therapy in a patient with relapsed/refractory multiple myeloma.


In this presentation on relapse refractory multiple myeloma treatment decision-making, Caitlin Costello, MD, an Associate Clinical Professor of Medicine, discusses best practices and strategies. The case presented involves a 75-year-old woman diagnosed with multiple myeloma in August 2017, presenting with fatigue and intense lower back pain after four lines of therapy.

The patient's medical history includes ISS stage 2 myeloma, chronic kidney disease stage 3b, and recurrent urinary tract infections. On examination, she has a performance status of 2 by ECOG criteria. Further evaluations reveal 70% BCMA-positive plasma cells in the bone marrow, a gain of 1q in FISH evaluation, and elevated LDH at 281.

Dr Costello emphasizes a comprehensive approach considering patient-related, treatment-related, and disease-related factors when designing the next line of therapy. Patient-specific factors include living conditions, social support, and logistical considerations. Treatment-related considerations involve assessing prior toxicities, while disease-related factors encompass the type and pace of relapse.

For this patient, with prior exposure to CD38 monoclonal antibodies and proteasome inhibitors, Dr. Costello advises against repeating these classes. Given the patient's age, frailty, and comorbidities, a tailored approach considering her individual circumstances, including limited caregiver support, is recommended. The goal is to choose a therapy with remaining sensitivity and minimal overlap with previous treatments, acknowledging the evolving nature of the disease.

Summary was AI-generated and edited for clarity.

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