Overcoming Multiple Myeloma: A 63-Year-Old Man's Journey to Recovery Through Timely Diagnosis and Targeted Chemotherapy

Case Summary: This medical case highlights the successful treatment journey of a 63-year-old male patient, Mr. Liu, who presented with persistent fever, chest discomfort, and lower back pain lasting over three months. Initially attributing his symptoms to a previous spinal injury, he delayed seeking medical attention until the condition worsened. Upon comprehensive evaluation at our hospital, he was diagnosed with multiple myeloma—a rare blood cancer affecting plasma cells. Further tests revealed complications including lumbar compression fractures and severe anemia. He underwent surgical intervention for fracture stabilization, followed by targeted chemotherapy using bortezomib and dexamethasone, along with erythropoietin therapy to manage anemia. After four cycles of treatment and a 20-day inpatient stay, his disease was effectively controlled, significantly improving his quality of life and functional status.

Patient Profile & Clinical Background

Age & Gender: 63-year-old maleDiagnosis: Multiple Myeloma (symptomatic, stage II based on ISS)Hospital: Sun Yat-sen University Cancer CenterDate of Admission: September 2016Treatment Plan: Surgical fixation for vertebral fractures + Bortezomib-Dexamethasone (BD) chemotherapy regimen + subcutaneous injections of recombinant human erythropoietinTreatment Duration: 20 days of inpatient care, followed by four outpatient chemotherapy cycles and ongoing monitoringOutcome: Significant clinical improvement, symptom remission, and enhanced daily functioning

Initial Consultation: Recognizing the Warning Signs

Mr. Liu first visited our clinic after enduring unexplained chest and lower back pain for nearly three months, accompanied by intermittent low-grade fever (up to 37.9°C). He had fallen four months earlier, resulting in a lumbar fracture, which he assumed was the cause of his ongoing discomfort. However, as symptoms failed to improve with rest and basic pain management, he sought further evaluation.

On physical examination, clinicians noted signs of moderate anemia—pallor, fatigue, and tenderness over the lumbar spine. Vital signs showed mild fever without respiratory or neurological abnormalities. Laboratory analysis revealed alarming hematologic results: 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—indicating possible bone marrow suppression.

Imaging played a critical role in diagnosis. MRI of the lumbar spine detected abnormal signal intensities across multiple vertebrae, suggesting infiltrative disease. Subsequent CT scans confirmed compressive fractures at L1 and L5 with characteristic "punched-out" lytic lesions—classic radiological features of multiple myeloma. Given these findings, immediate hospitalization was recommended for definitive diagnosis and multidisciplinary management.

Diagnostic Confirmation and Treatment Strategy

Once admitted, serum protein electrophoresis was performed, revealing a prominent M-protein spike—a hallmark of monoclonal gammopathy. To confirm the diagnosis, a bone marrow aspiration and biopsy were conducted. Microscopic analysis showed extensive infiltration of atypical plasma cells, accounting for over 30% of nucleated cells in the marrow, leading to a conclusive diagnosis of multiple myeloma.

After discussing the prognosis and treatment options with Mr. Liu and his family, a comprehensive plan was initiated. First, recombinant human erythropoietin was administered to correct symptomatic anemia and reduce transfusion dependence. Once stabilized, orthopedic specialists performed spinal fixation surgery to address structural instability caused by the pathologic fractures.

Following surgical recovery, the patient began the BD chemotherapy protocol—bortezomib (a proteasome inhibitor) combined with intravenous dexamethasone (a corticosteroid). This regimen is widely recognized for its efficacy in newly diagnosed multiple myeloma cases, particularly among older adults who may not be candidates for stem cell transplantation. Four full cycles were scheduled at three-week intervals, with close monitoring for toxicity.

Monitoring Response and Managing Side Effects

Throughout the chemotherapy phase, Mr. Liu tolerated treatment remarkably well. The most notable side effect was mild nausea, which resolved spontaneously without requiring antiemetic intervention. No peripheral neuropathy, significant cytopenias, or infections were observed—a testament to careful dosing and supportive care.

Serial laboratory assessments demonstrated progressive normalization of blood counts and reduction in M-protein levels. Follow-up imaging six weeks post-treatment showed stabilization of the affected vertebrae and no new lytic lesions. These outcomes indicated a partial but meaningful response to therapy, sufficient to restore mobility and independence.

Recovery and Long-Term Management Recommendations

By day 20 of hospitalization, Mr. Liu's pain had markedly decreased, energy levels improved, and vital signs normalized—meeting criteria for discharge. He transitioned to outpatient follow-up with scheduled lab work every four weeks to monitor disease burden and organ function.

To support sustained remission and overall wellness, I provided the following guidance:

• Monitor for Treatment-Related Complications: Report any severe gastrointestinal distress—including persistent vomiting or diarrhea—as these could indicate infection or drug intolerance.
• Nutrition and Lifestyle: Adopt a balanced diet rich in fruits, vegetables, lean proteins, and whole grains. Stay well-hydrated and avoid alcohol and tobacco, which can impair immune function and exacerbate bone loss.
• Optimize Sleep Environment: Use a firm mattress or hardboard bed to support spinal alignment and prevent further injury. Maintain a clean, well-ventilated living space to minimize infection risk.
• Engage in Gentle Physical Activity: When medically cleared, incorporate light exercise such as walking or tai chi to improve circulation, muscle strength, and mental health.
• Infection Prevention and Emotional Wellbeing: Practice good hygiene, avoid crowded places during flu season, and protect skin from cuts or abrasions. Equally important is maintaining social connections and a positive mindset—mental resilience plays a key role in long-term recovery.

Clinical Insights and Public Health Implications

This case underscores the importance of early detection in hematologic malignancies like multiple myeloma. Although often insidious in onset, classic warning signs—such as bone pain, unexplained fevers, fatigue, and anemia—should prompt thorough investigation, especially in individuals over 60.

Luckily, Mr. Liu did not present with advanced complications such as hypercalcemia, renal failure, or amyloidosis, allowing for effective intervention before irreversible damage occurred. His favorable outcome reflects both timely access to care and adherence to modern therapeutic protocols.

Key Takeaway: Routine annual health screenings are essential for older adults. Early diagnosis not only improves survival rates but also preserves quality of life. Patients experiencing persistent musculoskeletal pain, weight loss, or recurrent infections should seek prompt medical evaluation—even if symptoms seem minor or attributable to aging.

With continued innovation in targeted therapies and immunomodulatory drugs, the outlook for multiple myeloma patients has never been more promising. This case serves as a hopeful reminder that with vigilance, science, and compassionate care, even rare cancers can be managed successfully.