Case Study 3 - Question 3 | FocusOn Oncology

Question 3

Patient history: Helen, a 70-year-old retired architect, was diagnosed with multiple myeloma 2 years ago. She returns for consultation 6 months after ASCT.

Treatment regimen and response: Helen achieved CR after 6 cycles of D-VRd induction therapy. After stem cell collection, she received daratumumab-lenalidomide (DR) maintenance therapy with reduced doses of lenalidomide (10 mg daily). Helen underwent ASCT 16 months after diagnosis, when she experienced disease relapse. She has since continued DR maintenance therapy.
Comorbidities: atrial fibrillation, well-controlled hypertension, and mild asthma.
Current presentation: Laboratory values remain stable, reflecting CR. Positron emission tomography scans and next-generation sequencing show that Helen has remained negative for minimal residual disease (MRD) for the past 4 months. Hematology values show that Helen is experiencing moderate neutropenia (ANC: 0.8 x 10/L), thrombocytopenia (75,000/mcL), and anemia (Hb: 9.2 g/dL). She reports fatigue, weakness, shortness of breath, urinary frequency, nausea, and loss of appetite. She also experienced a few episodes of paroxysmal atrial fibrillation 30 days after ASCT.
Challenge: Helen was not able to return to work full-time following stem cell transplantation and eventually retired. She complains that the maintenance therapy continues to affect her quality of life. She asks if she can discontinue therapy and switch to observation only.

Choose your next step:

a. Stop therapy and monitor for disease progression every 3 months

b. Switch to lenalidomide-only maintenance, continue until disease progression

c. Continue DR maintenance up to 12 months²

d. Continue DR maintenance, reduce the dose of lenalidomide by 50%, and reassess in 2 months

Question 3

Question 3

Choose your next step:

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