Elderly Patient Achieves Positive Outcome After Chemotherapy for Multiple Myeloma

When 63-year-old Mr. Liu first came to our hospital complaining of persistent back and chest pain accompanied by low-grade fever, his condition was initially mistaken for a lingering effect from a previous fall. However, after thorough evaluation, he was diagnosed with multiple myeloma — a type of blood cancer affecting plasma cells. Thanks to early detection and an integrated treatment plan involving surgery, chemotherapy, and supportive care, Mr. Liu responded remarkably well to treatment. His symptoms improved significantly, and his quality of life has since been restored.

Case Overview: Key Information at a Glance

• Patient: Male, 63 years old
• Diagnosis: Multiple Myeloma
• Hospital: Sun Yat-sen University Cancer Center
• Date of Admission: September 2016
• Treatment Plan: Surgical intervention (vertebral fracture fixation), chemotherapy (bortezomib and dexamethasone), and erythropoietin injections for anemia
• Treatment Duration: 20-day hospitalization followed by four cycles of chemotherapy and ongoing follow-up
• Outcome: Disease under control, significant improvement in daily functioning and overall well-being

Initial Consultation: Recognizing the Warning Signs

Mr. Liu had experienced dull but persistent pain in his chest and lower back for three months, along with intermittent fever reaching up to 37.9°C. Initially attributing these symptoms to a prior lumbar spine injury from a fall four months earlier, he delayed seeking medical attention. As the discomfort failed to resolve, he decided to visit our clinic for further assessment.

On physical examination, he presented signs of moderate anemia and tenderness over the lumbar vertebrae. Vital signs showed a slightly elevated temperature. Blood tests revealed critical findings: hemoglobin at just 52 g/L (severe anemia), red blood cell count of 2.28×10¹²/L, white blood cell count of 4.7×10⁹/L, and platelets at 72×10⁹/L. These results pointed toward systemic involvement beyond simple musculoskeletal trauma.

To investigate further, imaging studies were ordered. An MRI of the lumbar spine detected abnormal signal intensities across multiple vertebral bodies and associated structures, suggesting possible malignant infiltration. A subsequent CT scan confirmed compression fractures at L1 and L5 with characteristic "punched-out" lesions — a hallmark radiological sign often seen in multiple myeloma.

Given the suspicious findings, we recommended hospital admission for comprehensive diagnostic workup. The patient agreed, marking the beginning of a targeted treatment journey.

Diagnostic Confirmation and Treatment Strategy

Once admitted, additional laboratory testing was performed. Serum protein electrophoresis revealed a prominent M-protein spike, strongly indicating monoclonal gammopathy. To confirm the diagnosis, a bone marrow aspiration and biopsy were conducted. Microscopic analysis confirmed clonal plasma cell proliferation consistent with multiple myeloma.

A Multimodal Approach to Care

With the diagnosis established, we discussed the treatment roadmap with Mr. Liu and his family. Given the presence of symptomatic spinal fractures and severe anemia, a stepwise approach was essential:

1. Anemia Management: Recombinant human erythropoietin was administered via injection to stimulate red blood cell production and alleviate fatigue and weakness.
2. Surgical Intervention: After hematologic stabilization, orthopedic specialists performed a vertebral fixation procedure to stabilize the fractured lumbar segments and prevent neurological complications.
3. Chemotherapy Regimen: Following recovery from surgery, Mr. Liu began a standardized BD protocol consisting of bortezomib (a proteasome inhibitor) and dexamethasone (a corticosteroid). This combination is widely recognized for its efficacy in newly diagnosed multiple myeloma patients.

The full course included four planned cycles of chemotherapy, each carefully monitored for response and tolerability.

Treatment Response and Recovery Progress

By day 20 of hospitalization, Mr. Liu's general condition had improved markedly. His pain levels decreased, energy returned, and vital parameters stabilized. He met discharge criteria and transitioned to outpatient care.

Throughout the four cycles of chemotherapy, side effects were minimal — only mild nausea occurred, which did not require antiemetic intervention or dose modification. Regular follow-ups tracked key markers including serum M-protein levels, complete blood counts, and imaging studies. All indicators showed progressive normalization, confirming effective disease suppression.

Most importantly, Mr. Liu reported a dramatic improvement in his ability to perform daily activities — walking without assistance, sleeping better, and regaining appetite — all clear signs of enhanced quality of life.

Ongoing Care: Essential Tips for Long-Term Success

While the initial outcome is encouraging, long-term management remains crucial for sustained remission. I advised Mr. Liu on several evidence-based lifestyle and monitoring practices:

1. Monitor for Treatment Side Effects

Patients undergoing chemotherapy should remain vigilant for severe gastrointestinal reactions such as persistent vomiting or diarrhea. Immediate medical review can prevent dehydration and ensure treatment continuity.

2. Maintain a Balanced, Nutrient-Rich Diet

A diet high in fruits, vegetables, lean proteins, and whole grains supports immune function and tissue repair. Staying well-hydrated helps reduce the risk of kidney complications, which are more common in myeloma patients due to excess protein excretion.

3. Optimize Sleep and Living Environment

I recommended that Mr. Liu sleep on a firm mattress to support spinal health and avoid soft, elastic beds that may worsen posture. Keeping living spaces clean, quiet, and well-ventilated reduces infection risks — especially important during immunosuppressive therapy.

4. Engage in Gentle Physical Activity

Low-impact exercises like walking or tai chi help maintain mobility, strengthen bones, and improve mood. Exercise also enhances circulation and immune surveillance, contributing to better overall outcomes.

5. Prioritize Mental Health and Infection Prevention

Practicing good hygiene, avoiding cuts or skin injuries, and staying socially connected are key. Emotional resilience plays a major role in recovery; maintaining a positive mindset through conversation, hobbies, or counseling can make a real difference.

Clinical Insights: Why Early Detection Matters

Multiple myeloma arises from uncontrolled growth of plasma cells in the bone marrow, leading to bone destruction, anemia, kidney dysfunction, and increased infection risk. In Mr. Liu's case, timely presentation allowed us to intervene before irreversible organ damage — such as hypercalcemia, renal failure, or uric acid nephropathy — developed.

This case underscores the importance of routine health screenings, particularly for adults over 60. Symptoms like unexplained bone pain, chronic fatigue, weight loss, or recurrent infections should never be dismissed as normal aging. Early diagnosis enables earlier initiation of targeted therapies, greatly improving prognosis.

Advances in treatment, including novel agents like bortezomib and personalized supportive care, have transformed multiple myeloma from a rapidly progressive illness into a manageable chronic condition for many patients. With proper care, individuals like Mr. Liu can enjoy meaningful recovery and extended survival.