Three of these choices—history of stroke, high-risk cytogenetics, and history of tibial fracture—are all relevant components of the patient’s presentation. However, the history of MM with high-risk cytogenetics is likely the most important aspect. Although the first-line regimen induced remission, MM is almost never "cured," particularly without transplant. The presence of high-risk cytogenetics (del17p positivity) strongly suggests the likelihood of relapse.
A history of stroke is a red flag for further cerebrovascular events and should be investigated if it has not been previously. Long-term anticoagulation is a risk given the gait problems, but given the increased incidence of venous thromboembolism with many MM therapies, there may be added benefit from continuing this. Finally, although some late-occurring complication with the patient's previous tibial fracture may be contributing to ongoing gait issues, new-onset pain in both legs and weakness are less likely to be related.
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Cite this: Maria-Victoria Mateos, Simon J. Harrison. Skill Checkup: An Elderly Man With Leg Pain and Weakness - Medscape - Apr 04, 2022.