Worsening low back pain
Our patient attributed his back pain to a recent fall, but his lab work and a sagittal CT pointed us in another direction.
A 2-pronged Tx approach
There has been a paradigm shift in the treatment of multiple myeloma in the past decade, and while it appears to be incurable with current approaches, considerable progress has been made.5 Median survival prior to 1997 was nearly 2.5 years; it is now nearly 4 years for patients diagnosed in the last decade.5
Treatment of multiple myeloma generally consists of systemic chemotherapy to control progression and supportive care to prevent serious complications. The standard treatment has traditionally consisted of intermittent pulses of an alkylating agent and prednisone administered for 4 to 7 days every 4 to 6 weeks.
Complications requiring supportive therapy include infections (eg, in the urinary tract), pneumonia, hypercalcemia, and renal failure. Of note, hypercalcemia and renal failure may be alleviated with adequate hydration. If necessary, more aggressive management with dialysis may be initiated.
Other considerations include the administration of allopurinol during chemotherapy, which may help control hyperuricemia from tumor lysis. Transfusions may be required for anemic patients, and plasmapheresis may be indicated to treat hyperviscosity syndrome.
Our patient improves
In the hospital our patient began 4 days on dexamethasone, a 7-day regimen of plasmapheresis, and dialysis. He was also started on a proteasome inhibitor (bortezomib), a newer antineoplastic agent approved for the treatment of multiple myeloma.6 The patient responded well and was discharged home with hematology-oncology follow-up, where he remains clinically improved after treatment with a combination of bortezomib and dexamethasone.
CORRESPONDENCE
Vincent Timpone, MD, Department of Radiology, David Grant United States Air Force Medical Center, Travis Air Force Base, CA 94535; vincent.timpone@travis.af.mil
