Devita, Hellman, and Rosenberg's Cancer

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

Chapter 34•Plasma Cell Neoplasms 465

Question 34.4. A 58-year-old woman is incidentally found to have a monoclonal protein

on SPEP with a monoclonal protein concentration of 1.7 g/dL, and on

immunofixation she is found to have monoclonal IgG kappa free light

chains. She is asymptomatic, and clinical examination results are normal.

Her laboratory investigations show an Hb of 13.1 g/dL, creatinine of

0.7 mg/dL, serum albumin of 4.7 g/dL, calcium of 9.3 mg/dL, and beta-

2 microglobulin of 1.7 mg/L. The skeletal survey was negative for any

lytic lesions. Bone marrow examination shows 13% plasma cells, and

cytogenetics shows normal female karyotype. What is the chance of this

patient developing multiple myeloma at 5 years?

A. 5%

B. 10%

C. 30%

D. 50%

Question 34.5. A 78-year-old male presents with history of severe back pain. X-rays of

the spine show multiple lytic lesions. Laboratory investigations reveal an

Hb of 13.2 g/dL, creatinine of 1.1 mg/dL, calcium of 8.6 mg/dL, and

albumin of 4.2 g/dL. Serum electrophoresis shows a 3.8 g/dL M-protein,

IgG Kappa on immunofixation. His bone marrow reveals 40% plasma

cells. He is started on I.V bortezomib 1.3 mg/m^2 (days 1, 4, 8 and 11 of

28 days cycle) and dexamethasone. After completing the first cycle, he

presents with a burning sensation and tingling in the hands and feet. On

examination, he has decreased sensation in upper and lower extremities.

His current SPEP shows a monoclonal protein level of 3.4 g/dL. All of the

following would be appropriate regarding continuing with bortezomib

therapy except:

A. Decrease the dose of bortezomib

B. Change bortezomib to once weekly administration

C. Change bortezomib to subcutaneous route

D. Make no change

Question 34.6. A 58-year-old woman was diagnosed with IgG kappa multiple myeloma

8 months ago when she presented with bone pain, multiple lytic lesions,

and an M-protein level of 5.8 g/dL. She was treated with lenalidomide

along with dexamethasone for four cycles following which her M-protein

decreased to 1.2 g/dL. She then underwent an autologous stem cell trans-

plant following which her M protein levels decreased further to 0.2 g/dL.

Of the following maintenance options, all have been shown to improve

survival EXCEPT:

A. Thalidomide

B. Lenalidomide

C. Pomalidomide

D. Bortezomib