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Case #812
Multiple Myeloma

A 54-year-old female with right hip pain

Original Release Date: October 31, 2008
Review Date: November 5, 2009
Expiration Date: November 4, 2010

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Chief Complaint

Sudden onset of pain in right hip

History of Present Illness

Aided by her family, Karen arrives at the emergency room complaining of abrupt-onset right hip pain extending deep into the groin. She denies trauma, stating that the pain arose as she retrieved groceries from the trunk of her car and made it nearly impossible for her to bear weight. She also admits to intermittent bouts of right hip pain during the preceding 2-3 weeks, which she attributed to arthritis and was relieved partially by ibuprofen.


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Disclosures and Important Information

Supported by an educational grant from Millennium Pharmaceuticals, Inc.

Original Release Date: October 31, 2008

Review Date: November 5, 2009

Expiration Date: November 4, 2010

Estimated time to complete this activity: 2.0 hours

Accreditation Statement

MedCases, LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education.

Credit Designation Statement

MedCases designates this educational activity for a maximum of 2.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Statement of Responsibility

MedCases takes responsibility for the content, quality, and scientific integrity of this CME activity.

Course Director and Principal Faculty

Kraft Family Professor of Medicine
Harvard Medical School
Chief, Division of Hematologic Neoplasia
Director, Jerome Lipper Multiple Myeloma Center
Dana-Farber Cancer Institute
Boston, MA

Director, Multiple Myeloma Program
Center for Excellence for Lymphoma & Myeloma
New York Presbyterian Hospital
Cornell University
New York, NY

Genevive Teuton Professor of Medicine
Feinberg School of Medicine
Director
Robert H. Lurie Comprehensive Cancer Center
Northwestern University
Chicago, IL

Independent Reviewer

Instructor, Adult Oncology
Harvard Medical School
Myeloma Program Medical Staff
Dana-Farber Cancer Institute
Boston, MA

Target Audience

This activity is intended for hematologists and community oncologists.

Prerequisites

There are no prerequisites.

Statement of Need

Significant progress has been made in diagnosis, assessment, and treatment of patients with multiple myeloma. The utilization of new classes of therapy, as well as improved strategies for managing toxicities of these medications, have resulted in new and more effective options that can prolong disease control and survival. Clinicians are now able to change the traditional goals to a more ambitious objective of achieving a complete response, in the hopes of longer progression-free survival and improved quality of life for their patients. Further, the need for stem cell transplants and the potential for associated medical complications may continue to diminish based on the potential for achieving complete remissions with combination therapy in newer protocols.

However, healthcare practitioners are faced with overcoming several clinical barriers quickly to achieve optimal outcomes in their patients. The rapidity of change in this continually evolving arena may cause delays incorporating newer evidence into clinical practice. Lack of familiarity with the newer protocols and the mechanisms of action of newer agents, the potential for adverse effects, and concerns about management of toxicities are all important obstacles in updating the clinical paradigms. Overcoming these obstacles will enable physicians to apply updated guidelines and current evidence to improve the quality of care for multiple myeloma patients.

Objectives

After completing this activity, you should be able to:

Execute diagnostic and monitoring protocols appropriate for multiple myeloma
Differentiate between relapse of multiple myeloma and disease progression
Implement therapy for treatment-naïve and relapsed myeloma patients within current standards of care

Method of Participation

This Internet-based activity takes approximately 2 hours to complete. You should review the objectives and cases, answer the multiple-choice posttest, and complete an evaluation form online. Once completed, you will be able to save your certificate to your own computer and print it on your own printer.

Disclosure Statement

As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is MedCases policy to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a provider has with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The following was reported:

Faculty
Kenneth C. Anderson, MD	Consultant and Grant/Research Support: Celgene Corporation, Millenium Pharmaceuticals, Novartis Pharmaceuticals
Ruben Niesvizky, MD	Speakers Bureau: Celgene Corporation, Millenium Pharmaceuticals, Novartis Pharmaceuticals, Ortho Biotech Grant/Research Support: Celgene Corporation, Millenium Pharmaceuticals Consultant: Millenium Pharmaceuticals
Irene Ghobrial, MD	Speakers Bureau: Celgene Corporation, Millenium Pharmaceuticals
Steven T. Rosen, MD, FACP	Consultant: Abbott Laboratories, Allos Therapeutics, Berlex Laboratories, Biocryst Pharmaceuticals, Celgene Corporation, Cell Therapeutics Inc.,Genentech Inc., Genta, Ligand Pharmaceuticals, Eli Lilly and Co., Pharmion Corporation, Sigma-Tau Pharmaceuticals, SuperGen, Therakos Inc., Wyeth

Planning Committee Members
Dorothy Schirf, MD	Stockholder: Alkermes, Inc., Ligand Pharmaceuticals, Northfield Laboratories, Inc., Pfizer, Inc.

Harvey Mossman, MD and Carolyn Darrow, MPH have indicated that they have not received financial support for consultation, research, evaluation, or have a financial interest relevant to this activity.

Notice of Off-Label Use Presentations

In accordance with US Food and Drug Administration (FDA) requirements regarding the disclosure of off-label, investigational, or unapproved recommendations for the use of drugs or devices, you are advised that content in this activity does not contain reference(s) to uses of drugs or devices that are off-label, investigational, or unapproved in the United States. The following information is provided for educational purposes and not to endorse off-label use.

No faculty member has indicated that their presentation will include information on off-label products.

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For Further Information

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Phone (609) 454-0680
Fax (609) 951-0112
cme@medcases.com

Hardware/Software Requirements and Technical Assistance

This Web-based CME activity is best experienced using a current generation browser, such as Internet Explorer 5.5 or higher. This Web site requires that JavaScript and session cookies be enabled. In addition, you will require the Adobe Flash Player plugin to view the case simulation.

Detailed Requirements:

128 MB RAM
Windows 98 or newer
Adobe Flash Player 8 minimum needed
Audio playback with speakers for programs that have video content
Internet Explorer 5.5 or higher or Mozilla Firefox 1.0 or higher or Apple Safari
1024 x 768 resolution
Broadband connection highly recommended

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Confirmation

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