C09974636 / invoice 10000

02/03/2026 CLINICIAN: Lydia Hambrook
PRESENTING COMPLAINT: Review multiple myeloma
HISTORY: 


Current therapy:
* Cyclophosphamide 60mg PO once q 2wks (last dose 18/2)
* Telmisartan 10mg PO sid (1/4 of a 40mg tablet PO sid) - alter dose based on BP/azotaemia if needed
* Prednisolone 2.5mg PO sid
* Fish oil 500mg PO sid
* RC renal diet sachet 

PHYSICAL EXAM: BAR. Vocal. MM pale pink, CRT <2s. No skin tent. Thoracic auscultation unremarkable. HR 140 bpm. RR  bpm. Abdominal palpation unremarkable. Peripheral lymph node palpation normal. Good coat. Temp 37.2. BW  5.3 kg (was 5.41kg).

DIAGNOSTIC TESTS: 
* Systolic BP 120 mmHg cuff 3 tail doppler (was 180)
* PCV/TP - 20/81, clear (was 30/87 pre-sedation, and 29/85 post-sedation last time)
* Standard profile

Previously:
revealed a moderate non-regenerative anaemia (RCC 3.8, Hct 0.18, retic 6). Marked rouleaux. Mild stress lymphopenia (0.1). Platelets normal (>300). Biochem revealed a stable azotaemia (urea 13, creat 255). Moderate elevation in CK (1047) - but blood sample collected after IM injection of sedation.

Trends:
Date:         RCC      Hct          Neutro       Platelets       TP         Globulins     Creat     Urea    Phos    UPC       Comment:
1/7/25        5.5        0.27         6.5             301              136        110              174        16        1.2      4.1
22/7/25      5.0        0.23        1.0              333              106        77                151       14.7     1.0       1.6          Three doses of melphalan (2mg twice weekly)
29/7/25      5.06      0.23         0.7             >300            97          66 (<50)      174       14.2     0.9        -             Reduced dose to 2mg q 5 days
5/8/25        4.83      0.22         0.1             >300            91          59                165       17.4     0.7       0.6          Pause melphalan
12/8/25      4.45      0.22         0.4             >300            92          60                173       11.8     0.8      
19/8/25      4.18      0.20         1.2             > 300           88          56                145       13.4     0.9                      Restart melphalan 0.5mg q 7d
26/8/25      4.15      0.20         3.2             443              89          56                154       13.6     0.8       -              After first maintenance dose
9/9/25        4.89      0.23         5.3             321              82          48                183       13.9     0.9       0.4
7/10/25      6.10      0.24         2.5             Clumped      88          54                182       13.8    1.0        - 
29/10/25    5.84      0.25         3.8             Normal         87          53                196       14.2     0.9       
18/11/25    4.66      0.20         3.5              >300           84           50                178       14.7     0.8       -              ** On gabapentin
16/12/25    4.83     0.22          3.0             249              85          53                 194       15.6     1.0       -             Still a small monoclonal gammopathy present **
7/1/26        5.25     0.23          2.6             >300            86          53                 241       12.3     0.9       0.2         On increased dose of melphalan 0.5mg PO eod
27/1/26      4.78     0.21          1.4              Normal        85          51                210        15.6     0.9      -              Rare polychromasia. Retic 2. Liver enzymes low.
17/2/26      3.8       0.18          2.1             >300             77         45                 255        13.0     1.2     0.2           CK 1047 (likely due to IM sedation).
02/03/26    3.79     0.17          0.7             236               79         47                 221        13.3     1.0      -             CK 65

DIAGNOSIS: 
* Multiple myeloma - in remission
* Protein losing nephropathy and borderline hypertension, IRIS CKD Stage 2 - likely secondary to multiple myeloma, currently controlled
* Moderate anaemia of chronic disease - slightly worsening, may be an element of myelosuppression, CKD +/- splenic sequestration due to gabapentin (PCV more robust than the Hct - NB. blood or the CBC was collected after sedation, PCV was pre-sedation).
* HCM Stage B1

TREATMENT: 
Continue:
* Cyclophosphamide 60mg PO once q 2wks - next dose due 4/3
* Telmisartan 10mg PO sid (1/4 of a 40mg tablet PO sid) - alter dose based on BP/azotaemia if needed
* Prednisolone 2.5mg PO sid
* Fish oil 500mg PO sid
* RC renal diet sachet 

PLAN: 


PROGNOSIS: 

CLIENT COMMUNICATION: