From Bedbound to Ambulatory: Reversing Disability in Patients with Multiple Myeloma Through Early and Aggressive Intervention

Introduction/Background/Significance: Multiple myeloma (MM) frequently manifests with severe bone involvement, including vertebral pathological fractures and mechanical instability, leading to significant loss of mobility and functional decline. In patients with limited performance status, early initiation of systemic therapy can reduce tumor burden and facilitate substantial physical recovery and restoration of independence. We present a case series of four patients who were bed-bound at diagnosis and experienced transformative recovery following aggressive therapeutic intervention.

Materials and Methods/Case Presentation/Objective: We retrospectively reviewed four patients with newly diagnosed MM who presented with Eastern Cooperative Oncology Group Performance Status (ECOG) 4, characterized by complete disability, inability to perform self-care, and confinement to bed. All patients were initiated on multi-agent systemic therapy tailored to clinical presentation and tolerance. Cytogenetic profiles, overall response, and functional milestones were tracked over time.

Results/Description/Main Outcome Measures: Patient 1, a 56-year-old female with light chain MM, stage II and standard-risk cytogenetics, had multiple plasmacytomas including a large multilobulated right sacral alar mass compromising mobility. She was initiated on Daratumumab, Bortezomib, Lenalidomide, and Dexamethasone (Dara-VRD), later switched to Dara-KRD due to neuropathy. She progressed from gurney-bound, prone status to ambulating with assistance, achieved a stringent complete response (sCR), and underwent an autologous stem cell transplant (ASCT). At last follow-up, she was day +56 post-ASCT and doing well.

Patient 2, a 67-year-old female with light chain MM, stage II and standard risk cytogenetics, presented with multiple vertebral pathological features. She was initially treated with CyBorD and later transitioned to lenalidomide and dexamethasone (oral Rd), which she could not tolerate. Her regimen was changed to Selinexor-Pomalidomide-Dexamethasone (Sel-PD). Despite initial immobility and socioeconomic barriers, she achieved sCR, graduated from community college, and was accepted into a University of California institution to pursue further education

Patient 3, a 32-year-old male with IgG kappa MM, stage II and standard risk cytogenetics, presented with extensive spinal involvement. He improved with Dara-VRD but experienced progression due to treatment nonadherence. He was transitioned to Isatuximab, Carfilzomib, and Dexamethasone (Isa-KD) and achieved a deep biochemical response. He regained strength, resumed driving, and now ambulates with a cane.

Patient 4, a 69-year-old male with stage III MM and high-risk cytogenetics [t(4;14), t(14;16), gain 1q], was initiated on IMROZ quadruplet regimen (Isa-VRD). He improved from gurney-bound status to ambulating over 700 feet with a walker. He achieved a very good partial response (VGPR) and transitioned to maintenance therapy.

All patients achieved substantial functional and hematologic recovery. Median time to physical improvement, defined as independent ambulation or transfer, was 10 weeks. On average, M-protein levels decreased by ~75%, with three of four patients achieving VGPR or better by the time they regained mobility. Improvement in IgG, free light chains, cytopenias, and renal function paralleled functional gains. One patient underwent ASCT. These cases highlight the potential for systemic therapy to reverse profound disability in patients with MM.

Conclusions: Aggressive, personalized therapeutic intervention, including quadruplet regimens, can yield deep overall responses and dramatic functional restoration. Poor performance status at diagnosis should not preclude treatment. Restoring independence is a critical and attainable goal in modern MM management.