Devita, Hellman, and Rosenberg's Cancer

LWBK1006-34 LWW-Govindan-Review November 24, 2011 11:25

464 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 34.2. A 59-year-old man is evaluated for anemia with an Hb of 9.2 g/dL. He has

no other medical comorbidities and is asymptomatic. His clinical exam-

ination reveals no abnormality. He is found to have a high total protein

of 12 g/dL and albumin of 3.2 g/dL. His serum creatinine is 1.0 mg/dL

and serum calcium is 9.3 mg/dL. He has an SPEP that shows a mon-

oclonal protein level of 8.6 g/dL, and serum immunofixation shows an

IgG lambda monoclonal protein. His skeletal survey is normal. His serum

beta-2 microglobulin is 4.3 mg/L. He has a bone marrow examination

that shows 40% plasma cells, and cytogenetic analysis reveals a normal

male karyotype. He is being considered for autologous stem cell trans-

plantation. Which of the following induction regimens would give the best

chance of complete remission after autologous stem cell transplantation?

A. Vincristine, Adriamycin, and dexamethasone (VAD)

B. TD

C. Bortezomib and dexamethasone (VD)

D. Bortezomib, thalidomide, and dexamethasone (VTD)

Question 34.3. A 52-year-old woman is evaluated for progressive fatigue. Clinical exam-

ination is remarkable only for pallor. Further investigation reveals an Hb

of 8.2 g/dL with mean corpuscular volume of 88 fL. Her iron studies,

vitamin B 12 levels, and folate levels are normal. Her serum creatinine is

0.8 mg/dL. Her SPEP reveals a monoclonal protein level of 3.8 g/dL,

and serum immunofixation shows a monoclonal IgG kappa light chain

protein. Further investigation reveals a calcium of 8.8 mg/dL, albumin of

4.2 g/dL, and beta-2 microglobulin of 2.1 mg/L. Skeletal survey shows

multiple lytic lesions. She has a bone marrow examination that shows

80% cellular marrow with 50% plasma cells. Cytogenetic analysis

shows normal female karyotype, and a fluorescence in situ hybridization

(FISH) panel is positive for 13q deletion in 50% of plasma cells. Which of

the following treatment options would be considered MOST appropriate

for the patient?

A. Bortezomib/dexamethasone induction followed by high-dose mel-

phalan and autologous stem cell transplantation (HDCT)

B. Bortezomib and dexamethasone with no option for HDCT

C. MP

D. MPT