Figure 1. Serum M-protein and kappa FLC levels over time from initial diagnosis. a: Induction therapy: lenalidomide (25 mg); dexamethasone (40 mg); and added bortezomib (1.3 mg/m2) in April 2011. b: Stem cell collection and AHCT, resulting in a VGPR. c: Maintenance therapy with lenalidomide (15 mg, days 1 - 21), 28-day cycles, resulted in remission. d: First relapse: treatment with RVd (lenalidomide 15 mg, bortezomib 1.3 mg/m2, dexamethasone 40 mg). e: Maintenance therapy with bortezomib 1.3 mg/m2, added dexamethasone (40 mg) on days of bortezomib dosing in January 2016. f: Second relapse. The following treatments were tried and failed: Rvd, ixazomib monotherapy, ixazomib + lenalidomide, elotuzumab + Rd. g: Treatment with nelfinavir, elotuzumab, bortezomib, and dexamethasone of 21-day cycles started on Aug 8, 2017. FLC: free light chains; AHCT: autologous hematopoietic cell transplant; VGPR: very good partial response; RVd: lenalidomide, bortezomib, dexamethasone; Rd: lenalidomide and dexamethasone.