Part 2: Multiple Myeloma
Todd Zimmerman, MD
Dr. Zimmerman is an associate professor of medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL.
Question 1
A 53-year-old woman with a history of IgA/kappa multiple myeloma presents to the local emergency department with worsening nausea, fatigue, and mental status changes. She had achieved very good partial response after an autologous transplant 2 years ago. She tried a brief course of thalidomide maintenance therapy, which she did not tolerate. On physical examination, she is lethargic and oriented to person and place. She is afebrile and orthostatic. Results of serum chemistries reveal a markedly elevated serum calcium level at 15.9 mg/dL, a serum albumin level of 3.2 g/dL, and a total protein level that has increased to 10.4 g/dL from a recent value of 8.1 g/dL. Serum creatinine is 1.7 mg/dL (baseline, 1.0 mg/dL). What is the next step in the management of this patient?
