Case Study 3 - Question 2 | FocusOn Oncology

Question 2

Patient history: Helen, a 68-year-old moderately active woman, was diagnosed with multiple myeloma 6 months ago. She is considered eligible for ASCT and has completed 6 cycles of D-VRd induction therapy. Helen achieved PR after 4 cycles and CR after 6 cycles of D-VRd therapy. She was treated for respiratory infections twice, after the second and the fifth D-VRd cycles.

Comorbidities: atrial fibrillation, uncontrolled hypertension, and mild asthma.
Current presentation: Helen reports persistent fatigue, weakness, joint pain, and headaches. Her ECOG performance status remains at level 1. She also presents with stage 2 hypertension.
Helen’s renal function remains normal. Hematology tests indicate that anemia has not resolved (Hb: 9.0 g/dL). Moderate neutropenia (ANC: 0.8 x 10/L) and thrombocytopenia (70,000/mcL) are also detected.
Challenge: Helen complains about the treatment-related side effects, which have affected her work performance and have limited her participation in family activities, such as spending time with her grandchildren. Given her history, the patient also worries about the risk of infection after transplantation. She states that she does not want a treatment that may require extensive time away from work.

Choose your next step:

a. Continue D-VRd induction therapy up to 8 cycles

b. Refer to cardiologist and prepare for ASCT

c. Cancel ASCT, continue D-VRd therapy indefinitely, and refer to cardiologist

d. Stop therapy until the cytopenia and infections resolve, postpone ASCT

e. Delay ASCT and consider maintenance therapy, with reduced doses of lenalidomide (10-15 mg daily)