Treatment regimen and response: Luis achieved VGPR after 6 cycles of DRd. Dexamethasone was discontinued after 9 months to reduce the risk of neuropsychiatric toxicity. He continued daratumumab, with adjustment of the lenalidomide dose (5 mg/day). Daratumumab and lenalidomide were discontinued at 16 months, when Luis experienced relapse and presented with new symptoms and osteolytic lesions on imaging.

A salvage regimen of pomalidomide, bortezomib, and low-dose dexamethasone (PVd) has been administered for the past 8 months. Luis had pneumonia after the second PVd cycle and an upper respiratory tract infection after the fourth cycle.

Current presentation: Luis complains of fatigue, asthenia, and symptoms of peripheral neuropathy. His family reports that he has experienced insomnia and irritability, and has exhibited signs of depression.

Laboratory results show partial response (PR), with a 70% reduction in M protein levels. Chemistry values do not indicate deterioration of the renal function. Hematology tests show anemia (Hb: 8.0 g/dL), grade 3 neutropenia (ANC: 0.5 x 10/L), and thrombocytopenia (50,000/mcL).

Imaging does not detect any new osteolytic lesions, nor increased metabolic activity.