Autologous Hematopoietic Stem-Cell Transplantation for Multiple Myeloma

A previously healthy 59-year-old man presents with persistent pain in his lower back and fatigue. A complete blood count reveals a hemoglobin level of 9.8 g per deciliter. A monoclonal protein (M component) is detected on serum protein electrophoresis and is characterized as an IgG kappa by immunofixation. A radiologic skeletal bone survey shows diffuse lytic bone lesions of the vertebrae and the pelvis. The diagnosis of multiple myeloma is confirmed by bone marrow aspiration, which reveals an infiltrate of 32% plasma cells. The serum calcium and creatinine levels are normal, the albumin level is 3.7 g per deciliter, and the beta(2)-microglobulin level is 2.8 mg per liter. Fluorescence in situ hybridization of bone marrow plasma cells shows deletion of chromosome 13, with no adverse prognostic factors. Considering the patient's relatively young age and the absence of coexisting illnesses, a hematologist recommends induction therapy followed by high-dose therapy with autologous hematopoietic stem-cell transplantation as the initial treatment.