Table 1.

Case timeline

Date	Presenting symptoms	Work-up (findings)	Treatment	Outcomes
09/2011	None	Diagnosed (asymptomatic) λ-light-chain multiple myeloma (DS Stage II, Group A; ISS, Stage 1)	Conservative	Became symptomatic
09/2013	Symptomatic disease	Re-evaluation by Medical Oncology	Induction therapy with 4 cycles of bortezomib, lenalidomide, and low-dose dexamethasone; Autologous stem cell transplant; maintenance therapy with lenalidomide	Symptoms improved, disease stabilized
09/2014	None (Medical Oncology re-evaluation)	Clinical remission	Maintenance therapy with lenalidomide	Asymptomatic
7/2015	Symptoms: Confusion, headache, nausea/vomiting, and recurrent falls	none	Conservative	Symptoms progressed
09/2015–10/2015	Worsening of symptoms, hematologic abnormalities	MRI of head (large mass involving left temporal lobe with edema and midline shift)	Admission to hospital for dexamethasone and stereotactic biopsy (Grade IV fibrillary astrocytoma: Glioblastoma multiforme); ventriculostomy shunt from neurosurgery; whole-brain palliative radiation therapy (10 fractions of 30 Gy-40 Gy) from radiation oncology	Symptoms improved after shunt placement and radiation therapy
10/2015	Clinical deterioration with dyspnea	Chest X-ray (hospital-associated pneumonia)	Power of attorney opted for hospice (discontinuation of radiation therapy)	Patient died

DS = Durie-Salmon Staging System; ISS = International Staging System; MRI = magnetic resonance image.