Multiple Myeloma:  New Approaches to Therapy

Cynthia E. Dunbar, MD; Arthur W. Nienhuis, MD
JAMA. 1993;269(18):2412-2416. doi:10.1001/jama.1993.03500180104043.
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SELECTED CASE  A 57-year-old woman with multiple myeloma was referred to the National Heart, Lung, and Blood Institute for autologous bone marrow transplantation. She developed rib and back pain in October 1990. Her pain progressed and in May 1991 she was found to have a sedimentation rate of 131 mm/h, osteopenia, and anemia. She was referred to a hematologist, and workup revealed a total protein level of 101 g/L with a monoclonal IgA-λ of 52 g/L. Laboratory values were as follows: creatinine, 159.12 μmol/L (1.80 mg/dL); calcium, 2.74 mmol/L (11.00 mg/dL); and hemoglobin 99 g/L, with normal leukocyte and platelet counts; β2 microglobulin was elevated, at 449175 nmol/L (5300 mg/L). Bone marrow aspiration and biopsy revealed 60% plasma cells, and roentgenograms revealed lytic lesions in the skull, humeri, and spine.The patient was treated with six cycles of monthly oral melphalan and prednisone. Her back pain resolved after two


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