Treatment options for MM have significantly improved over the past two decades. Whereas MM was previously considered incurable, the introduction of proteasome inhibitors (eg, bortezomib, carfilzomib) and immunomodulatory drugs (eg, lenalidomide, thalidomide) has made treatment more effective and less toxic compared with previous regimens. Newer medications have allowed many patients to achieve the goal of deep remission, with prolonged, treatment-free survival.
The patient in this case went through six cycles of induction chemotherapy, which included bortezomib and dexamethasone. This is the standard first-line treatment for MM. The treatment was well tolerated. Because he was younger than 65 years, he received high-dose therapy with melphalan, followed by autologous hematopoietic stem cell transplant (HSCT) using peripheral blood progenitor cells. He underwent single autologous HSCT, because a trial showed no benefit of second autologous HSCT in the context of newer agents.
Although the role of maintenance therapy is unclear in older patients, on the basis of phase 3 randomized trials showing benefit in younger patients, the patient was prescribed ongoing lenalidomide. Approximately 18 months after he first presented, the patient is doing well. In addition to successful treatment for MM, his depression has improved, and he is now engaged to his girlfriend. He is adhering to a follow-up schedule.
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