65M w/ MDS/MPN-unspecified (5-10% blasts on marrow, normal karyotype but 7 tier 1 molecular lesions). Not a transplant candidate. He has a very proliferative phenotype. Symptoms have improved with hydrea and then 2 rounds of decitabine but he has become transfusion dependent (1-2 pRBCs/week), WBC remains >80k, and repeat marrow is unchanged with >95% cellularity and 8% blasts. Do you think Ven/Aza is appropriate?
Myeloma patient off treatment due to severe recurrent UTI's, AKI, poor PS who is now ready to resume therapy. Her Hb is 7.7, GFR 29, iron sat 12%, ferritin 1400 (likely had UTI at the time). Would you proceed with IV iron even with such an elevated ferritin?
I have an 80y old with new diagnosis of smoldering myeloma (15% plasma cells), no CRAB but KLR 0.08. She also has RA and her Rheum would like to start rituxan and low dose MTX. 1. Is it ok to go ahead with rituxan? 2. Would treating the myeloma help the RA. Thoughts?