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Symptomatic multiple myeloma — ABIM Board MCQ

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ModerateHematology/OncologySymptomatic multiple myelomaABIM Board

A 63-year-old man has bone pain, fatigue, and recurrent infections. Hemoglobin is 8.9 g/dL, creatinine is 2.3 mg/dL, calcium is 12.1 mg/dL, and total protein is 10.2 g/dL. Serum free light chain ratio is markedly abnormal, and bone marrow biopsy shows 45% clonal plasma cells. Which of the following is the most appropriate management?

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Correct answer: B — Myeloma-directed systemic therapy with renal-protective supportive care

CRAB features with clonal marrow plasma cells establish symptomatic multiple myeloma, requiring systemic anti-myeloma therapy and supportive care for hypercalcemia, kidney injury, infection risk, and bone disease.

Reference: NCCN Multiple Myeloma Guideline