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70-Year-Old Male with New Leg Pain

Joseph is a 70-year-old retired educator. He was diagnosed with multiple myeloma just over three years ago. He was classified as standard risk. He received VRd induction followed by ASCT (autologous stem cell transplantation) with lenalidomide as maintenance for two years.

At his last appointment, he complained of new leg pain. A skeletal survey confirmed new lesions in his femur and ribs. There are no new genetic anomalies.

Joseph suffers from neuropathy. His cardiac function is normal. He resides within a 15-minute drive from the clinic. His medical team discusses treatment options:

IV proteasome inhibitor as a single agent
Adding proteasome inhibitor, carfilzomib, to lenalidomide and dexamethasone (KRd)
What are the pros and cons for Joseph and his family to consider as they decide on his next treatment?

Is there prophylaxis that Joseph should be given?


  • He needs prophylaxis with Bactrim and acyclovir. VTE prophylaxis.
    1 month