Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

MKSAP: 50-year-old woman with advanced multiple myeloma

mksap
Conditions
June 11, 2011
38 Shares
Share
Tweet
Share

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 50-year-old woman with advanced multiple myeloma diagnosed 6 months ago undergoes a follow-up visit. Treatment includes daily oral thalidomide and pulse dexamethasone. The patient now feels well.

Laboratory studies indicate a serum monoclonal protein concentration of 3.0 g/dL (30 g/L). Hemoglobin concentration, serum calcium level, and renal function studies are normal. A bone marrow aspirate shows reduction in plasma cells from 50% to 10%.

Which of the following is the most appropriate treatment to optimize this patient’s disease-free and overall survival?

A) Autologous stem cell transplantation
B) Continuation of oral thalidomide
C) Initiation of parenteral bisphosphonates
D) Initiation of oral melphalan

Answer and critique

The correct answer is A) Autologous stem cell transplantation.

Thalidomide plus dexamethasone is standard first-line chemotherapy for patients younger than 65 years who are candidates for autologous stem cell transplantation. The overall response rate to this chemotherapy is approximately 65% to 75%. In patients who do have a favorable hematologic response to initial therapy, several randomized clinical trials have shown improvement in both overall and disease-free survival if these patients are subsequently treated with autologous stem cell transplantation. Patients who have no contraindications to intensive therapy with thalidomide and dexamethasone and autologous stem cell transplantation should therefore be offered this treatment as the best option to improve overall and disease-free survival.

Continuation of thalidomide with or without dexamethasone cannot be recommended, although clinical trials are evaluating the effectiveness of this agent as maintenance therapy after stem cell transplantation. Thalidomide has not been studied in this setting and is not approved for this indication. Furthermore, it is unknown whether thalidomide confers a survival advantage compared with autologous stem cell transplantation for patients with advanced multiple myeloma who have responded to initial therapy. Although parenteral bisphosphonates may reduce or prevent skeletal complications in patients with multiple myeloma, they do not improve disease-free survival.

Oral melphalan should not be used in patients who are potential candidates for stem cell transplantation because this treatment can impair the future collection of peripheral stem cells necessary for stem cell transplantation.

Key Point

  • Autologous stem cell transplantation following high-dose chemotherapy can improve overall and disease-free survival in patients with multiple myeloma.

Learn more about ACP’s MKSAP 15.

This content is excerpted from MKSAP 15 with permission from the American College of Physicians (ACP). Use is restricted in the same manner as that defined in the MKSAP 15 Digital license agreement. This material should never be used as a substitute for clinical judgment and does not represent an official position of ACP. All content is licensed to KevinMD.com on an “AS IS” basis without any warranty of any nature. The publisher, ACP, shall not be liable for any damage or loss of any kind arising out of or resulting from use of content, regardless of whether such liability is based in tort, contract or otherwise.

Prev

Medicare's high cost end stage renal disease patients

June 11, 2011 Kevin 1
…
Next

How to take care of your health during difficult economic times

June 11, 2011 Kevin 0
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
Medicare's high cost end stage renal disease patients
Next Post >
How to take care of your health during difficult economic times

More by mksap

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 26-year-old man with back pain

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 36-year-old man with abdominal cramping, diarrhea, malaise, and nausea

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 52-year-old woman with osteoarthritis of the right hip

    mksap

More in Conditions

  • The surprising power of Play-Doh in pediatric care: How it’s bringing families together

    Alexander Rakowsky, MD
  • Lazarus: the dead man brought back to life

    William Lynes, MD
  • The psychoanalytic hammer: lessons in listening and patient-centered care

    Greg Smith, MD
  • 5 essential tips to help men prevent prostate cancer

    Kevin Jones, MD
  • Changing the pediatric care landscape: Integrating behavioral and mental health care

    Hilary M. Bowers, MD
  • Unlocking the secret to successful weight loss: Curiosity is the key

    Franchell Hamilton, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Don’t be caught off guard: Read your malpractice policy today

      Aaron Morgenstein, MD & Laura Fortner, MD | Physician
    • The dark side of medicine: an urgent call to action against greed

      Don Gaede, MD | Physician
    • The surprising power of Play-Doh in pediatric care: How it’s bringing families together

      Alexander Rakowsky, MD | Conditions
    • Breaking free from gaslighting [PODCAST]

      The Podcast by KevinMD | Podcast
    • The pros and cons of using ChatGPT for your health care needs

      Liudmila Schafer, MD | Tech
    • Dr. Glaucomflecken for president!

      Aaron Morgenstein, MD & Amy Bissada, DO & Corinne Sundar Rao, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Dear Congress, Here's How to Fix the Clinician Shortage
  • How Did Pulse Oximeters Perform in Black Kids?
  • Coffee and Heart Function; Ionizing Radiation and CVD
  • Health Inequity Should Be Labeled as a 'Never Event'
  • Healing the Damaged Nurse-Physician Dynamic

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Don’t be caught off guard: Read your malpractice policy today

      Aaron Morgenstein, MD & Laura Fortner, MD | Physician
    • The dark side of medicine: an urgent call to action against greed

      Don Gaede, MD | Physician
    • The surprising power of Play-Doh in pediatric care: How it’s bringing families together

      Alexander Rakowsky, MD | Conditions
    • Breaking free from gaslighting [PODCAST]

      The Podcast by KevinMD | Podcast
    • The pros and cons of using ChatGPT for your health care needs

      Liudmila Schafer, MD | Tech
    • Dr. Glaucomflecken for president!

      Aaron Morgenstein, MD & Amy Bissada, DO & Corinne Sundar Rao, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

MKSAP: 50-year-old woman with advanced multiple myeloma
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...