Frequent MUGA testing in a myeloma patient: A case-based ethics discussion
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A 51-year-old African-American male with a history of relapsed refractory IgA lambda myeloma status post stem cell transplant and many salvage therapies was referred to the nuclear cardiology laboratory in June 2015 for equilibrium radionuclide ventriculography (multigated acquisition; MUGA) to evaluate left ventricular function since he was recently started on a new regimen, which includes the mitogen-activated protein kinase kinase inhibitor trametinib, a potentially cardiotoxic chemotherapeutic agent. His diagnosis of multiple myeloma was first made 7 years prior to presentation to the nuclear lab; at that time he had presented with anemia, hypercalcemia, back pain, lytic bone lesions on CT scan, and markedly elevated total protein and low albumin. Bone marrow biopsy confirmed the suspicion of multiple myeloma. He was initially seen at a local office and subsequently referred to a quaternary care center drawing myeloma patients from across the United States and...
Dr Schwartz reports serving on the speakers bureau for Astellas Dr Einstein reports receiving grant support to Columbia University for other research from GE Healthcare, Philips Healthcare, and Toshiba America Medical Systems.
- 1.VanRhee F, Szymonifka J, Anaissie E, et al. Total therapy 3 for multiple myeloma: Prognostic implications of cumulative dosing and premature discontinuation of VTD maintenance components, bortezomib, thalidomide and dexamethasone, relevant to all phases of therapy. Blood. 2010;116:1220–7.CrossRefGoogle Scholar
- 4.Plana JC, Galderisi M, Barac A, et al. Expert consensus for multimodality imaging evaluation of adult patient during and after cancer therapy: A report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2013;27:911–39.CrossRefGoogle Scholar
- 6.Douglas PS, Garcia MJ, Haines DE, et al. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 Appropriate Criteria for Echocardiography. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance American College of Chest Physicians. J Am Soc Echocardiogr. 2011;24:229–67.CrossRefGoogle Scholar
- 7.Thavendiranathan P, Grant AD, Negishi T, Plana JC, Popović ZB, Marwick TH. Reproducibility of echocardiographic techniques for sequential assessment of left ventricular ejection fraction and volumes: application to patients undergoing cancer chemotherapy. J Am Coll Cardiol. 2013;61:77–84.CrossRefGoogle Scholar
- 12.Hendel RC, Berman DS, Di Carli MF, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate use criteria for cardiac radionuclide imaging: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine. J Am Coll Cardiol. 2009;53:2201–29.CrossRefGoogle Scholar