Create a blood cancer report of a unknown person
I'll need a few details to make this report realistic and useful. Let me ask a couple of quick questions first.
Asking for Preferences
What type of blood cancer report do you need? · What format should the report be in? · What is the report's purpose?
A clinical case report for Multiple Myeloma in PDF format. Let me gather the medical content and build this properly.
Reading File
Reading File
Now let me query the medical library for Multiple Myeloma content and search PubMed in parallel.
Finding Sources
Searching PubMed
"multiple myeloma"[MeSH Terms] AND "diagnosis"[MeSH Terms]
Now let me read the key textbook sections in parallel - Goldman-Cecil Medicine (main clinical reference) and Robbins Pathology.
Reading File
Reading File
Excellent content. Now let me read more of the Goldman-Cecil block for clinical management details, and also check the Lab Medicine block for diagnostic lab values.
Reading File
Reading File
Let me get the clinical features, diagnosis criteria, and treatment sections.
Reading File
Reading File
I now have rich clinical content. Let me update todos and build the PDF.
Running Command
mkdir -p /home/daytona/workspace/blood-cancer-report && ls /home/daytona/workspace/blood-cancer-report/
Writing File
~/blood-cancer-report/generate_report.py
from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm, mm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY, TA_RIGHT
from reportlab.platypus import (
SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
HRFlowable, KeepTogether
)
from reportlab.platypus import PageBreak
from reportlab.lib.colors import HexColor
import datetime
# ── Colour palette ──────────────────────────────────────────────────────────
DARK_BLUE = HexColor("#1a2e5a")
MID_BLUE = HexColor("#2c5282")
ACCENT_BLUE = HexColor("#3182ce")
LIGHT_BLUE = HexColor("#ebf4ff")
STEEL = HexColor("#4a5568")
LIGHT_GREY = HexColor("#f7fafc")
BORDER_GREY = HexColor("#cbd5e0")
RED = HexColor("#c53030")
AMBER = HexColor("#c05621")
GREEN = HexColor("#276749")
WHITE = colors.white
BLACK = colors.black
PAGE_W, PAGE_H = A4
MARGIN_L = 2.2 * cm
MARGIN_R = 2.2 * cm
MARGIN_T = 2.8 * cm
MARGIN_B = 2.5 * cm
OUTPUT = "/home/daytona/workspace/blood-cancer-report/Multiple_Myeloma_Clinical_Case_Report.pdf"
styles = getSampleStyleSheet()
# ── Custom paragraph styles ─────────────────────────────────────────────────
def make_style(name, parent="Normal", **kwargs):
s = ParagraphStyle(name, parent=styles[parent])
for k, v in kwargs.items():
setattr(s, k, v)
return s
cover_title = make_style("CoverTitle", fontSize=30, leading=38, textColor=WHITE,
spaceAfter=6, alignment=TA_CENTER, fontName="Helvetica-Bold")
cover_sub = make_style("CoverSub", fontSize=14, leading=20, textColor=HexColor("#bee3f8"),
spaceAfter=4, alignment=TA_CENTER)
cover_badge = make_style("CoverBadge", fontSize=11, leading=16, textColor=HexColor("#ebf8ff"),
spaceAfter=2, alignment=TA_CENTER)
h1 = make_style("H1", fontSize=14, leading=18, textColor=WHITE,
spaceBefore=0, spaceAfter=0, fontName="Helvetica-Bold",
alignment=TA_LEFT)
h2 = make_style("H2", fontSize=11, leading=15, textColor=DARK_BLUE,
spaceBefore=10, spaceAfter=3, fontName="Helvetica-Bold")
h3 = make_style("H3", fontSize=10, leading=14, textColor=MID_BLUE,
spaceBefore=6, spaceAfter=2, fontName="Helvetica-BoldOblique")
body = make_style("Body", fontSize=9.5, leading=14, textColor=STEEL,
spaceBefore=3, spaceAfter=3, alignment=TA_JUSTIFY)
body_bold = make_style("BodyBold", fontSize=9.5, leading=14, textColor=BLACK,
spaceBefore=3, spaceAfter=3, fontName="Helvetica-Bold")
bullet = make_style("Bullet", fontSize=9.5, leading=14, textColor=STEEL,
leftIndent=12, firstLineIndent=0, spaceBefore=1, spaceAfter=1,
bulletIndent=4)
label_style = make_style("Label", fontSize=8.5, leading=12, textColor=STEEL,
fontName="Helvetica-Bold")
value_style = make_style("Value", fontSize=9.5, leading=13, textColor=BLACK)
footer_style = make_style("Footer", fontSize=7.5, leading=10, textColor=BORDER_GREY,
alignment=TA_CENTER)
caption = make_style("Caption", fontSize=8, leading=11, textColor=STEEL,
alignment=TA_CENTER, fontName="Helvetica-Oblique")
disclaimer = make_style("Disclaimer", fontSize=8, leading=12, textColor=HexColor("#718096"),
alignment=TA_JUSTIFY)
# ── Helper builders ──────────────────────────────────────────────────────────
def section_header(title, color=DARK_BLUE):
"""Coloured banner row that acts as a section heading."""
tbl = Table([[Paragraph(title, h1)]], colWidths=[PAGE_W - MARGIN_L - MARGIN_R])
tbl.setStyle(TableStyle([
("BACKGROUND", (0, 0), (-1, -1), color),
("TOPPADDING", (0, 0), (-1, -1), 6),
("BOTTOMPADDING",(0, 0), (-1, -1), 6),
("LEFTPADDING", (0, 0), (-1, -1), 10),
("RIGHTPADDING", (0, 0), (-1, -1), 10),
("ROUNDEDCORNERS", [4]),
]))
return tbl
def info_table(rows, col_ratios=(0.38, 0.62)):
"""Two-column label/value table."""
usable = PAGE_W - MARGIN_L - MARGIN_R
widths = [usable * r for r in col_ratios]
data = [[Paragraph(lbl, label_style), Paragraph(val, value_style)] for lbl, val in rows]
tbl = Table(data, colWidths=widths, hAlign="LEFT")
tbl.setStyle(TableStyle([
("BACKGROUND", (0, 0), (0, -1), LIGHT_GREY),
("BACKGROUND", (1, 0), (1, -1), WHITE),
("GRID", (0, 0), (-1, -1), 0.4, BORDER_GREY),
("TOPPADDING", (0, 0), (-1, -1), 5),
("BOTTOMPADDING", (0, 0), (-1, -1), 5),
("LEFTPADDING", (0, 0), (-1, -1), 8),
("RIGHTPADDING", (0, 0), (-1, -1), 8),
("VALIGN", (0, 0), (-1, -1), "TOP"),
]))
return tbl
def lab_table(headers, rows, flag_col=None):
"""Full-width styled lab results table."""
usable = PAGE_W - MARGIN_L - MARGIN_R
col_count = len(headers)
widths = [usable / col_count] * col_count
header_cells = [Paragraph(h, make_style(f"th{i}", fontSize=8.5, fontName="Helvetica-Bold",
textColor=WHITE, alignment=TA_CENTER)) for i, h in enumerate(headers)]
table_data = [header_cells]
for row in rows:
styled_row = []
for i, cell in enumerate(row):
flag = False
if flag_col and i == flag_col and cell not in ("", "—"):
flag = "H" in cell or "L" in cell or "↑" in cell or "↓" in cell or "*" in cell
cell_style = make_style(f"td_{i}", fontSize=9, leading=13,
textColor=RED if flag else STEEL, alignment=TA_CENTER)
styled_row.append(Paragraph(str(cell), cell_style))
table_data.append(styled_row)
tbl = Table(table_data, colWidths=widths, hAlign="LEFT", repeatRows=1)
style = TableStyle([
("BACKGROUND", (0, 0), (-1, 0), MID_BLUE),
("ROWBACKGROUNDS",(0, 1), (-1, -1), [WHITE, LIGHT_BLUE]),
("GRID", (0, 0), (-1, -1), 0.3, BORDER_GREY),
("TOPPADDING", (0, 0), (-1, -1), 4),
("BOTTOMPADDING", (0, 0), (-1, -1), 4),
("LEFTPADDING", (0, 0), (-1, -1), 5),
("RIGHTPADDING", (0, 0), (-1, -1), 5),
("VALIGN", (0, 0), (-1, -1), "MIDDLE"),
])
tbl.setStyle(style)
return tbl
def highlight_box(text, bg=LIGHT_BLUE, border=ACCENT_BLUE):
"""Highlighted callout box."""
usable = PAGE_W - MARGIN_L - MARGIN_R
tbl = Table([[Paragraph(text, make_style("hb", fontSize=9.5, leading=14, textColor=DARK_BLUE,
alignment=TA_JUSTIFY))]],
colWidths=[usable])
tbl.setStyle(TableStyle([
("BACKGROUND", (0, 0), (-1, -1), bg),
("LEFTBORDERPADDING", (0, 0), (0, -1), 10),
("BOX", (0, 0), (-1, -1), 1.5, border),
("TOPPADDING", (0, 0), (-1, -1), 8),
("BOTTOMPADDING", (0, 0), (-1, -1), 8),
("LEFTPADDING", (0, 0), (-1, -1), 12),
("RIGHTPADDING", (0, 0), (-1, -1), 12),
]))
return tbl
def alert_box(text, bg=HexColor("#fff5f5"), border=RED, text_color=RED):
usable = PAGE_W - MARGIN_L - MARGIN_R
tbl = Table([[Paragraph(text, make_style("ab", fontSize=9.5, leading=14, textColor=text_color,
alignment=TA_JUSTIFY))]],
colWidths=[usable])
tbl.setStyle(TableStyle([
("BACKGROUND", (0, 0), (-1, -1), bg),
("BOX", (0, 0), (-1, -1), 1.5, border),
("TOPPADDING", (0, 0), (-1, -1), 8),
("BOTTOMPADDING", (0, 0), (-1, -1), 8),
("LEFTPADDING", (0, 0), (-1, -1), 12),
("RIGHTPADDING", (0, 0), (-1, -1), 12),
]))
return tbl
def green_box(text):
return highlight_box(text, bg=HexColor("#f0fff4"), border=HexColor("#38a169"))
# ── Page callbacks ────────────────────────────────────────────────────────────
def on_page(canvas, doc):
"""Draw header stripe + footer on every page except the cover."""
page = canvas.getPageNumber()
canvas.saveState()
if page > 1:
# Thin top rule
canvas.setFillColor(DARK_BLUE)
canvas.rect(0, PAGE_H - 1.6*cm, PAGE_W, 1.6*cm, fill=1, stroke=0)
canvas.setFillColor(WHITE)
canvas.setFont("Helvetica-Bold", 9)
canvas.drawString(MARGIN_L, PAGE_H - 1.1*cm, "CLINICAL CASE REPORT | MULTIPLE MYELOMA")
canvas.setFont("Helvetica", 8)
canvas.drawRightString(PAGE_W - MARGIN_R, PAGE_H - 1.1*cm, f"Page {page}")
# Bottom footer
canvas.setFillColor(BORDER_GREY)
canvas.setFont("Helvetica-Oblique", 7)
canvas.drawCentredString(PAGE_W / 2, 1.2*cm,
"CONFIDENTIAL — For educational/clinical purposes only. Not a substitute for professional medical judgment.")
canvas.setStrokeColor(BORDER_GREY)
canvas.setLineWidth(0.5)
canvas.line(MARGIN_L, 1.6*cm, PAGE_W - MARGIN_R, 1.6*cm)
canvas.restoreState()
# ── Document content ──────────────────────────────────────────────────────────
def build():
doc = SimpleDocTemplate(
OUTPUT,
pagesize=A4,
leftMargin=MARGIN_L,
rightMargin=MARGIN_R,
topMargin=MARGIN_T + 0.4*cm, # extra space for header stripe
bottomMargin=MARGIN_B,
title="Multiple Myeloma – Clinical Case Report",
author="Orris Medical System",
subject="Haematology / Oncology",
)
story = []
sp = lambda n=1: Spacer(1, n * 0.35 * cm)
# ─────────────────────────────────────────────────────────────────────────
# COVER PAGE
# ─────────────────────────────────────────────────────────────────────────
usable = PAGE_W - MARGIN_L - MARGIN_R
# Full-width cover banner
cover_data = [[
Paragraph("CLINICAL CASE REPORT", cover_sub),
],[
Paragraph("Multiple Myeloma", cover_title),
],[
Paragraph("IgG-κ Type | Stage III (ISS) | High-Risk Cytogenetics", cover_badge),
],[
Paragraph("Haematology & Oncology Department", cover_badge),
]]
cover_tbl = Table(cover_data, colWidths=[usable])
cover_tbl.setStyle(TableStyle([
("BACKGROUND", (0, 0), (-1, -1), DARK_BLUE),
("TOPPADDING", (0, 0), (-1, -1), 10),
("BOTTOMPADDING", (0, 0), (-1, -1), 10),
("LEFTPADDING", (0, 0), (-1, -1), 20),
("RIGHTPADDING", (0, 0), (-1, -1), 20),
("ROUNDEDCORNERS", [6]),
]))
story.append(cover_tbl)
story.append(sp(2))
# Date / Institution row
meta_data = [
["Report Date:", "01 June 2026",
"Institution:", "University Teaching Hospital"],
["Case Reference:", "UKN-MM-2026-001",
"Treating Consultant:", "Dr. [Attending Physician]"],
["Speciality:", "Haematology / Oncology",
"Report Prepared by:", "Oncology MDT"],
]
meta_tbl = Table(meta_data,
colWidths=[usable*0.18, usable*0.32, usable*0.18, usable*0.32])
meta_tbl.setStyle(TableStyle([
("BACKGROUND", (0, 0), (0, -1), LIGHT_GREY),
("BACKGROUND", (2, 0), (2, -1), LIGHT_GREY),
("GRID", (0, 0), (-1, -1), 0.4, BORDER_GREY),
("TOPPADDING", (0, 0), (-1, -1), 5),
("BOTTOMPADDING", (0, 0), (-1, -1), 5),
("LEFTPADDING", (0, 0), (-1, -1), 8),
("RIGHTPADDING", (0, 0), (-1, -1), 8),
("FONTNAME", (0, 0), (0, -1), "Helvetica-Bold"),
("FONTNAME", (2, 0), (2, -1), "Helvetica-Bold"),
("FONTSIZE", (0, 0), (-1, -1), 8.5),
("TEXTCOLOR", (0, 0), (0, -1), STEEL),
("TEXTCOLOR", (2, 0), (2, -1), STEEL),
]))
story.append(meta_tbl)
story.append(sp(1.5))
# Disclaimer
story.append(highlight_box(
"<b>NOTICE:</b> This report concerns an <b>unknown / de-identified patient</b> and is produced "
"for <b>educational and illustrative purposes only</b>. All patient identifiers are fictional. "
"Clinical data are constructed to represent a typical presentation of Multiple Myeloma based on "
"current evidence-based guidelines (Goldman-Cecil Medicine, 26th ed.; Robbins & Kumar Basic "
"Pathology, 10th ed.; EHA-EMN Guidelines 2025).",
bg=HexColor("#fffbeb"), border=HexColor("#d69e2e")
))
story.append(sp(1.5))
# ─────────────────────────────────────────────────────────────────────────
# 1. PATIENT DEMOGRAPHICS
# ─────────────────────────────────────────────────────────────────────────
story.append(section_header("1. PATIENT DEMOGRAPHICS"))
story.append(sp(0.5))
demo_rows = [
("Patient ID", "UKN-MM-2026-001 (de-identified)"),
("Age", "67 years"),
("Sex", "Male"),
("Ethnicity", "African-American (note: incidence ~2× higher vs. White population)"),
("Occupation", "Retired industrial chemist (possible benzene exposure history)"),
("Date of Admission", "15 April 2026"),
("Presenting to", "Haematology Outpatient Clinic → Emergency Admission"),
("Referral Source", "GP / Primary Care Physician"),
("Next of Kin", "Spouse (consented to educational data use)"),
("Insurance / Payor", "Not applicable (anonymised)"),
]
story.append(info_table(demo_rows))
story.append(sp(1))
# ─────────────────────────────────────────────────────────────────────────
# 2. CHIEF COMPLAINT & PRESENTING HISTORY
# ─────────────────────────────────────────────────────────────────────────
story.append(section_header("2. CHIEF COMPLAINT & PRESENTING HISTORY"))
story.append(sp(0.5))
story.append(Paragraph("Chief Complaint", h2))
story.append(Paragraph(
"Severe back pain, progressive fatigue, and recurrent episodes of bacterial pneumonia "
"over the preceding 8 months.",
body))
story.append(Paragraph("History of Presenting Illness", h2))
story.append(Paragraph(
"The patient is a 67-year-old male who presented with an 8-month history of worsening "
"lumbar and thoracic back pain (rated 7/10, mechanical in character, worse at rest), "
"profound fatigue limiting daily activities, unintentional weight loss of approximately "
"8 kg, and two hospitalizations for community-acquired pneumonia within 6 months.",
body))
story.append(Paragraph(
"He noted increasing difficulty walking due to lower-limb weakness over the past 3 weeks. "
"On the morning of admission, he experienced acute worsening of back pain following a "
"minor fall at home, prompting emergency presentation.",
body))
story.append(Paragraph("Symptom Timeline", h2))
timeline_data = [
["Timeframe", "Symptom / Event"],
["~8 months prior", "Onset of back pain; GP prescribed analgesics"],
["~7 months prior", "First episode of community-acquired pneumonia (hospitalized)"],
["~5 months prior", "Progressive fatigue; blood tests ordered by GP — noted anaemia"],
["~4 months prior", "Second pneumonia; serum protein electrophoresis sent — M-spike noted"],
["~3 months prior", "Referred to haematology; serum-free light chain assay abnormal"],
["~3 weeks prior", "Lower-limb weakness onset; constipation; increased thirst (hypercalcaemia)"],
["Day of admission","Acute back pain after fall; imaging showed T8 vertebral compression fracture"],
]
t = Table(timeline_data, colWidths=[usable*0.28, usable*0.72])
t.setStyle(TableStyle([
("BACKGROUND", (0, 0), (-1, 0), MID_BLUE),
("TEXTCOLOR", (0, 0), (-1, 0), WHITE),
("FONTNAME", (0, 0), (-1, 0), "Helvetica-Bold"),
("FONTSIZE", (0, 0), (-1, -1), 8.5),
("ROWBACKGROUNDS",(0, 1), (-1, -1), [WHITE, LIGHT_BLUE]),
("GRID", (0, 0), (-1, -1), 0.3, BORDER_GREY),
("TOPPADDING", (0, 0), (-1, -1), 4),
("BOTTOMPADDING", (0, 0), (-1, -1), 4),
("LEFTPADDING", (0, 0), (-1, -1), 7),
("RIGHTPADDING", (0, 0), (-1, -1), 7),
("VALIGN", (0, 0), (-1, -1), "TOP"),
]))
story.append(t)
story.append(sp(1))
# ─────────────────────────────────────────────────────────────────────────
# 3. PAST MEDICAL HISTORY
# ─────────────────────────────────────────────────────────────────────────
story.append(section_header("3. PAST MEDICAL HISTORY"))
story.append(sp(0.5))
pmh_rows = [
("Hypertension", "Diagnosed 12 years ago; on amlodipine 5 mg OD"),
("Type 2 Diabetes", "Diagnosed 9 years ago; HbA1c 7.2% — managed with metformin 1 g BD"),
("Hyperlipidaemia", "On atorvastatin 20 mg OD"),
("Monoclonal Gammopathy (MGUS)", "Detected incidentally 3 years prior; IgG-κ 1.2 g/dL; monitored annually — not treated"),
("Osteoporosis", "DEXA scan 2 years prior showed T-score −2.8 (spine); on calcium + vitamin D"),
("No prior malignancy", "No personal or family history of myeloma; no prior radiotherapy"),
("Surgical History", "Appendicectomy (age 32); right inguinal hernia repair (age 55)"),
("Allergies", "Penicillin — rash (documented). No other known drug allergies."),
]
story.append(info_table(pmh_rows))
story.append(sp(1))
# ─────────────────────────────────────────────────────────────────────────
# 4. PHYSICAL EXAMINATION
# ─────────────────────────────────────────────────────────────────────────
story.append(section_header("4. PHYSICAL EXAMINATION"))
story.append(sp(0.5))
story.append(Paragraph("Vital Signs", h2))
vitals_data = [
["Parameter", "Value", "Reference", "Flag"],
["Blood Pressure", "148/90 mmHg", "< 130/80", "↑ Elevated"],
["Heart Rate", "96 bpm", "60–100", "Normal"],
["Temperature", "37.8 °C", "36.1–37.2", "↑ Low-grade fever"],
["SpO₂ (room air)", "95%", "≥ 95%", "Borderline"],
["Respiratory Rate", "18/min", "12–20", "Normal"],
["Weight", "72 kg (↓8 kg over 8 mo)", "—", "↓ Significant loss"],
["Height", "175 cm", "—", "BMI 23.5"],
]
story.append(lab_table(vitals_data[0], vitals_data[1:], flag_col=3))
story.append(Paragraph("General Findings", h2))
exam_rows = [
("General", "Pale, fatigued-appearing male; in moderate distress due to back pain"),
("HEENT", "No lymphadenopathy; no mucosal pallor; no JVP elevation"),
("Respiratory", "Reduced breath sounds at right base; dull percussion — residual effusion (post-pneumonia)"),
("Cardiovascular", "Regular rate; no murmurs; peripheral pulses intact"),
("Abdomen", "Soft, non-tender; liver span 13 cm (borderline hepatomegaly); no splenomegaly"),
("Musculoskeletal", "Point tenderness over T8 and L3 vertebrae; kyphotic posture; restricted lumbar flexion"),
("Neurological", "Power 4/5 bilateral lower limbs; intact sensation; no bowel/bladder dysfunction currently"),
("Skin", "Pallor; no plasmacytomas or skin lesions noted"),
("Bone lesions", "No visible skull deformity; anterior chest wall tenderness over ribs bilaterally"),
]
story.append(info_table(exam_rows))
story.append(sp(1))
# ─────────────────────────────────────────────────────────────────────────
# 5. LABORATORY INVESTIGATIONS
# ─────────────────────────────────────────────────────────────────────────
story.append(PageBreak())
story.append(section_header("5. LABORATORY INVESTIGATIONS"))
story.append(sp(0.5))
story.append(Paragraph("5.1 Complete Blood Count (CBC)", h2))
cbc_headers = ["Test", "Result", "Reference Range", "Flag"]
cbc_rows = [
["Haemoglobin", "8.4 g/dL", "13.5–17.5 g/dL", "↓ LOW *"],
["MCV", "88 fL", "80–100 fL", "Normal"],
["WBC", "4.2 × 10⁹/L", "4.0–11.0 × 10⁹/L","Normal"],
["Platelets", "142 × 10⁹/L", "150–400 × 10⁹/L", "↓ LOW"],
["Reticulocyte count", "1.0%", "0.5–2.5%", "Normal"],
["Rouleaux formation", "Present", "Absent", "* ABNORMAL"],
]
story.append(lab_table(cbc_headers, cbc_rows, flag_col=3))
story.append(Paragraph("5.2 Comprehensive Metabolic Panel", h2))
cmp_headers = ["Test", "Result", "Reference Range", "Flag"]
cmp_rows = [
["Serum Calcium (corrected)", "12.8 mg/dL", "8.5–10.5 mg/dL", "↑ HIGH *"],
["Serum Creatinine", "2.1 mg/dL", "0.7–1.3 mg/dL", "↑ HIGH *"],
["eGFR", "31 mL/min", "≥ 60 mL/min", "↓ LOW *"],
["Total Protein", "10.2 g/dL", "6.0–8.3 g/dL", "↑ HIGH *"],
["Albumin", "2.9 g/dL", "3.5–5.0 g/dL", "↓ LOW"],
["LDH", "385 U/L", "135–225 U/L", "↑ HIGH"],
["Beta-2 Microglobulin", "7.4 mg/L", "< 2.5 mg/L", "↑ HIGH *"],
["Uric Acid", "8.1 mg/dL", "3.4–7.0 mg/dL", "↑ HIGH"],
["Serum Na / K", "136 / 4.2 mEq/L", "Normal ranges", "Normal"],
]
story.append(lab_table(cmp_headers, cmp_rows, flag_col=3))
story.append(Paragraph("5.3 Myeloma-Specific Laboratory Panel", h2))
mm_headers = ["Test", "Result", "Reference / Threshold", "Interpretation"]
mm_rows = [
["Serum Protein Electrophoresis (SPEP)", "M-spike 4.8 g/dL (IgG)", "No M-spike expected", "↑ ABNORMAL *"],
["Serum Immunofixation", "IgG-κ monoclonal band", "No monoclonal band", "POSITIVE *"],
["IgG level", "5,640 mg/dL", "700–1,600 mg/dL", "↑ HIGH *"],
["IgA level", "48 mg/dL", "70–400 mg/dL", "↓ LOW"],
["IgM level", "22 mg/dL", "40–230 mg/dL", "↓ LOW"],
["Serum Free Light Chains (κ)", "2,840 mg/L", "3.3–19.4 mg/L", "↑ ELEVATED *"],
["Serum Free Light Chains (λ)", "12 mg/L", "5.7–26.3 mg/L", "Normal"],
["κ/λ Ratio", "236.7", "0.26–1.65", "↑ ABNORMAL *"],
["24-hr Urine Protein", "2.2 g / 24 hr", "< 0.15 g / 24 hr", "↑ HIGH *"],
["Bence Jones Protein (urine IFE)", "Positive (κ light chains)", "Negative", "POSITIVE *"],
]
story.append(lab_table(mm_headers, mm_rows, flag_col=3))
story.append(sp(0.5))
story.append(highlight_box(
"<b>Key Point:</b> Serum protein electrophoresis detects an M protein in ~80% of myeloma patients. "
"Combined serum immunofixation and urine studies identify M protein in ~97% of cases. "
"The serum free light chain assay (κ/λ ratio) can also substitute for urine studies in the "
"diagnostic work-up. (Goldman-Cecil Medicine, 26th ed.)"
))
story.append(sp(1))
# ─────────────────────────────────────────────────────────────────────────
# 6. BONE MARROW BIOPSY
# ─────────────────────────────────────────────────────────────────────────
story.append(section_header("6. BONE MARROW BIOPSY & CYTOGENETICS"))
story.append(sp(0.5))
bm_rows = [
("Procedure", "Posterior iliac crest core biopsy + aspirate — 15 April 2026"),
("Plasma cell %", "38% of nucleated cells (clonal plasma cells) — markedly elevated (normal < 5%)"),
("Morphology", "Atypical plasma cells with prominent nucleoli, binucleated forms, and Russell bodies (cytoplasmic Ig inclusions)"),
("Immunohistochemistry", "CD138+, CD38+, CD45−, CD56+, κ light-chain restricted. CD20 negative (20% of MM express CD20)."),
("κ/λ IHC ratio", "κ:λ > 8:1 (confirms clonal κ population; normal 2–4:1)"),
("FISH Panel", "t(4;14)(p16;q32) positive — HIGH RISK cytogenetic abnormality; del(17p) detected in 22% of cells — HIGH RISK"),
("Conventional Karyotype", "46,XY, add(14)(q32) — complex karyotype; MYC rearrangement not detected"),
("CRAB Criteria met", "Hypercalcaemia (Ca 12.8), Renal failure (Cr 2.1), Anaemia (Hb 8.4), Bone lesions (vertebral + skull) — ALL FOUR present"),
]
story.append(info_table(bm_rows))
story.append(sp(0.5))
story.append(alert_box(
"⚠ HIGH-RISK CYTOGENETICS IDENTIFIED: t(4;14) and del(17p) are both independently associated "
"with significantly inferior progression-free and overall survival. Per IMWG/IMS 2025 Consensus "
"recommendations, this patient is classified as HIGH-RISK MULTIPLE MYELOMA. Intensified therapy "
"and closer monitoring protocols apply."
))
story.append(sp(1))
# ─────────────────────────────────────────────────────────────────────────
# 7. IMAGING
# ─────────────────────────────────────────────────────────────────────────
story.append(section_header("7. IMAGING STUDIES"))
story.append(sp(0.5))
img_rows = [
("Whole-body Low-dose CT\n(WBLDCT)",
"Multiple lytic ('punched-out') lesions: skull (3 lesions, largest 2.1 cm), ribs (bilateral), "
"T8 vertebral body compression fracture with 35% height loss, L3 lytic lesion, left proximal femur "
"cortical thinning. Pattern consistent with myeloma bone disease."),
("MRI Spine (Gadolinium)",
"T8 pathological compression fracture with posterior cortical bulge causing mild cord impingement "
"(no complete cord compression). T2 hyperintense signal in L1, L3, T10 vertebral bodies — diffuse "
"marrow infiltration pattern."),
("PET-CT (18F-FDG)",
"Diffuse skeletal uptake; SUVmax 4.8 at T8 lesion. No extramedullary disease or organ involvement "
"beyond skeletal system."),
("Chest X-Ray",
"Mild right-sided pleural effusion (resolving); no active consolidation; rib lucencies visible on "
"oblique views."),
("Echocardiogram",
"EF 58%; no cardiac amyloid features; mild LVH — attributed to hypertension."),
("Renal Ultrasound",
"Bilateral kidneys enlarged (right 13.2 cm, left 12.8 cm); increased echogenicity consistent with "
"myeloma nephropathy / cast nephropathy."),
]
story.append(info_table(img_rows, col_ratios=(0.28, 0.72)))
story.append(sp(1))
# ─────────────────────────────────────────────────────────────────────────
# 8. DIAGNOSIS & STAGING
# ─────────────────────────────────────────────────────────────────────────
story.append(PageBreak())
story.append(section_header("8. DIAGNOSIS & DISEASE STAGING"))
story.append(sp(0.5))
story.append(Paragraph("8.1 Formal Diagnosis", h2))
story.append(highlight_box(
"<b>CONFIRMED DIAGNOSIS:</b> Multiple Myeloma, IgG-κ type<br/>"
"Diagnostic criteria met (IMWG 2014 / Updated 2021): ≥ 10% clonal bone marrow plasma cells "
"(38% documented) PLUS M protein in serum (IgG 5,640 mg/dL; M-spike 4.8 g/dL) PLUS CRAB "
"features (all four: Hypercalcaemia, Renal insufficiency, Anaemia, Bone lesions).",
bg=HexColor("#ebf8ff"), border=DARK_BLUE
))
story.append(sp(0.5))
story.append(Paragraph("8.2 ISS (International Staging System)", h2))
iss_data = [
["ISS Criterion", "Patient Value", "Stage III Threshold", "Met?"],
["Serum Albumin", "2.9 g/dL", "< 3.5 g/dL", "Yes"],
["Beta-2 Microglobulin", "7.4 mg/L", "≥ 5.5 mg/L", "Yes"],
]
story.append(lab_table(iss_data[0], iss_data[1:], flag_col=3))
story.append(sp(0.3))
story.append(Paragraph(
"<b>ISS Stage:</b> <font color='#c53030'><b>III (High Risk)</b></font> — "
"β2-microglobulin ≥ 5.5 mg/L + serum albumin < 3.5 g/dL.",
make_style("iss_note", fontSize=9.5, textColor=DARK_BLUE)))
story.append(Paragraph("8.3 Revised ISS (R-ISS)", h2))
riss_data = [
["Component", "Finding", "Risk"],
["ISS Stage", "Stage III", "High"],
["t(4;14) by FISH", "Positive", "High-Risk Cytogenetic"],
["del(17p) by FISH", "Positive (22% of cells)", "High-Risk Cytogenetic"],
["Serum LDH", "385 U/L (> upper normal limit)", "Elevated"],
]
story.append(lab_table(riss_data[0], riss_data[1:], flag_col=2))
story.append(sp(0.3))
story.append(Paragraph(
"<b>R-ISS Stage: III</b> — Poor prognosis. Median OS approximately 33 months with conventional regimens; "
"significantly improved with quadruplet induction + ASCT in eligible patients.",
make_style("riss_note", fontSize=9.5, textColor=RED)))
story.append(sp(1))
# ─────────────────────────────────────────────────────────────────────────
# 9. PATHOPHYSIOLOGY SUMMARY
# ─────────────────────────────────────────────────────────────────────────
story.append(section_header("9. PATHOPHYSIOLOGY"))
story.append(sp(0.5))
story.append(Paragraph(
"Multiple myeloma originates from a malignant proliferation of terminally differentiated B cells "
"(plasma cells) in the bone marrow. Almost all cases evolve from a precursor monoclonal gammopathy "
"of undetermined significance (MGUS) — progressing at ~1% per year. This patient had a documented "
"MGUS (IgG-κ, 1.2 g/dL) 3 years prior.",
body))
story.append(Paragraph("Key Pathogenic Mechanisms", h2))
for item in [
("<b>Cytogenetic events:</b> t(4;14) fuses FGFR3/MMSET oncogenes to the IgH locus (14q32), "
"dysregulating cyclin D expression and driving plasma cell proliferation. del(17p) inactivates "
"TP53, a critical tumour suppressor, conferring genomic instability and chemo-resistance."),
("<b>IL-6 signalling:</b> Interleukin-6 from bone marrow stromal cells and fibroblasts is a "
"major myeloma cell growth factor. Autocrine and paracrine IL-6 loops sustain tumour survival."),
("<b>Bone destruction (CRAB – Bones):</b> Myeloma cells upregulate RANKL on stromal cells, "
"activating osteoclasts. Simultaneously, DKK1, IL-3, and IL-7 suppress osteoblasts → pure "
"osteolytic lesions with no reactive sclerosis, pathological fractures, and hypercalcaemia."),
("<b>Renal injury (CRAB – Renal):</b> κ Bence Jones proteins form obstructive casts in distal "
"tubules (myeloma cast nephropathy). Light chain deposition in glomeruli, hypercalcaemia-induced "
"nephrocalcinosis, and recurrent infections all compound renal damage."),
("<b>Immune suppression (CRAB – Anaemia / Infections):</b> Malignant plasma cells crowd out "
"normal haematopoiesis → normocytic anaemia. Functional immunoglobulin production is suppressed "
"despite elevated total protein → hypogammaglobulinaemia → recurrent bacterial infections."),
]:
story.append(Paragraph(f"• {item}", bullet))
story.append(sp(1))
# ─────────────────────────────────────────────────────────────────────────
# 10. TREATMENT PLAN
# ─────────────────────────────────────────────────────────────────────────
story.append(section_header("10. TREATMENT PLAN"))
story.append(sp(0.5))
story.append(Paragraph(
"The patient is a 67-year-old male with good performance status (ECOG 1), no major cardiac "
"comorbidity, and eGFR 31 mL/min. He is considered a <b>borderline transplant candidate</b>; "
"renal function recovery may improve eligibility. Treatment is guided by high-risk cytogenetics "
"and ISS III status.",
body))
story.append(Paragraph("10.1 Induction Therapy (Planned)", h2))
story.append(highlight_box(
"<b>Daratumumab + Bortezomib + Lenalidomide + Dexamethasone (Dara-VRd / D-VRd)</b><br/>"
"Quadruplet induction — 4 cycles (28-day cycles):<br/>"
"• Daratumumab 16 mg/kg IV (Days 1, 8, 15, 22 of cycles 1–2; then Days 1, 15 of cycles 3–4)<br/>"
"• Bortezomib 1.3 mg/m² SC (Days 1, 4, 8, 11)<br/>"
"• Lenalidomide 25 mg PO Days 1–21 (dose-reduced to 10 mg given eGFR 31)<br/>"
"• Dexamethasone 40 mg PO/IV weekly<br/>"
"<br/>"
"Rationale: High-risk cytogenetics [t(4;14) + del(17p)] warrant intensified upfront therapy. "
"Daratumumab-based quadruplets demonstrate superior MRD negativity rates and PFS vs. VRd triplet.",
bg=HexColor("#f0fff4"), border=HexColor("#276749")
))
story.append(Paragraph("10.2 Autologous Stem Cell Transplantation (ASCT)", h2))
story.append(Paragraph(
"Stem cell harvest planned after cycle 2 (mobilisation with G-CSF ± plerixafor). "
"If renal function improves (eGFR > 40), proceed to high-dose melphalan (200 mg/m² or "
"reduced-dose 140 mg/m²) conditioning followed by ASCT. ASCT remains standard of care for "
"eligible patients and improves event-free and overall survival vs. conventional chemotherapy alone. "
"(Goldman-Cecil Medicine, 26th ed.)",
body))
story.append(Paragraph("10.3 Maintenance Therapy", h2))
story.append(Paragraph(
"Post-ASCT: Lenalidomide maintenance (10 mg Days 1–21 of a 28-day cycle) until progression or "
"intolerance. For high-risk disease (del 17p), consider addition of bortezomib maintenance "
"(1.3 mg/m² every 2 weeks). Duration of maintenance: continuous until disease progression.",
body))
story.append(Paragraph("10.4 Supportive Care", h2))
supportive_data = [
["Issue", "Intervention"],
["Bone disease / pain", "Zoledronic acid 4 mg IV monthly (renally adjusted); vertebroplasty/kyphoplasty for T8 fracture if pain persists; orthopaedic referral for femur lesion"],
["Hypercalcaemia", "IV hydration (normal saline) + zoledronic acid; loop diuretic if fluid overloaded"],
["Renal failure", "Aggressive IV hydration; avoid NSAIDs and nephrotoxins; nephrology co-management; haemodialysis if renal function worsens"],
["Anaemia (Hb 8.4)", "Transfuse if symptomatic (target Hb > 9); erythropoiesis-stimulating agent consideration post-induction"],
["Infection prophylaxis","Aciclovir (VZV prophylaxis during bortezomib); co-trimoxazole (PCP prophylaxis); IVIG if recurrent severe infections"],
["DVT prophylaxis", "Aspirin or LMWH during lenalidomide therapy (IMiD-associated thrombosis risk)"],
["Neuropathy monitoring","Serial neurological assessments; reduce bortezomib dose/frequency if Grade ≥ 2 peripheral neuropathy"],
["Steroid side effects", "Gastric protection (PPI); blood glucose monitoring (known T2DM); bone protection"],
]
t2 = Table(supportive_data, colWidths=[usable*0.28, usable*0.72])
t2.setStyle(TableStyle([
("BACKGROUND", (0, 0), (-1, 0), MID_BLUE),
("TEXTCOLOR", (0, 0), (-1, 0), WHITE),
("FONTNAME", (0, 0), (-1, 0), "Helvetica-Bold"),
("FONTSIZE", (0, 0), (-1, -1), 8.5),
("ROWBACKGROUNDS",(0, 1), (-1, -1), [WHITE, LIGHT_BLUE]),
("GRID", (0, 0), (-1, -1), 0.3, BORDER_GREY),
("TOPPADDING", (0, 0), (-1, -1), 5),
("BOTTOMPADDING", (0, 0), (-1, -1), 5),
("LEFTPADDING", (0, 0), (-1, -1), 7),
("RIGHTPADDING", (0, 0), (-1, -1), 7),
("VALIGN", (0, 0), (-1, -1), "TOP"),
]))
story.append(t2)
story.append(sp(1))
# ─────────────────────────────────────────────────────────────────────────
# 11. PROGNOSIS
# ─────────────────────────────────────────────────────────────────────────
story.append(PageBreak())
story.append(section_header("11. PROGNOSIS & MONITORING"))
story.append(sp(0.5))
story.append(Paragraph("Prognostic Assessment", h2))
prog_rows = [
("ISS Stage", "III — poor prognosis"),
("R-ISS Stage", "III — high-risk; estimated median OS ~33 months with triplet therapy"),
("Cytogenetics", "t(4;14) + del(17p) — dual high-risk; significantly inferior PFS and OS"),
("LDH", "Elevated (385 U/L) — adverse prognostic marker in R-ISS"),
("Renal function", "CKD Stage 3b (eGFR 31) — reversible component expected with hydration + treatment"),
("ECOG Performance Status", "1 — favourable for intensive treatment"),
("Age", "67 years — borderline for full-dose ASCT; feasible with careful patient selection"),
("MRD-negativity potential", "Target: MRD-negative state post-ASCT (associated with significantly improved outcomes)"),
]
story.append(info_table(prog_rows))
story.append(Paragraph("Response Monitoring Schedule", h2))
monitor_data = [
["Timepoint", "Assessment"],
["Every 28 days (on-treatment)",
"CBC, metabolic panel, SPEP, serum IFE, free light chains, urine protein"],
["After cycle 2", "Response assessment per IMWG criteria; stem cell mobilisation if CR/VGPR"],
["After cycle 4", "Pre-ASCT staging: SPEP, BM biopsy, MRD by next-generation flow or NGS-MRD"],
["Day +100 post-ASCT", "Response assessment, MRD, bone survey, quality-of-life evaluation"],
["Every 3 months (maintenance)", "SPEP + IFE; free light chains; CBC; renal/calcium panel"],
["Annually", "Bone survey / PET-CT; echocardiogram; DEXA scan; full restaging if clinical change"],
["At progression", "Repeat BM biopsy with FISH panel; consider next-generation therapy"],
]
t3 = Table(monitor_data, colWidths=[usable*0.3, usable*0.7])
t3.setStyle(TableStyle([
("BACKGROUND", (0, 0), (-1, 0), MID_BLUE),
("TEXTCOLOR", (0, 0), (-1, 0), WHITE),
("FONTNAME", (0, 0), (-1, 0), "Helvetica-Bold"),
("FONTSIZE", (0, 0), (-1, -1), 8.5),
("ROWBACKGROUNDS",(0, 1), (-1, -1), [WHITE, LIGHT_BLUE]),
("GRID", (0, 0), (-1, -1), 0.3, BORDER_GREY),
("TOPPADDING", (0, 0), (-1, -1), 4),
("BOTTOMPADDING", (0, 0), (-1, -1), 4),
("LEFTPADDING", (0, 0), (-1, -1), 7),
("RIGHTPADDING", (0, 0), (-1, -1), 7),
("VALIGN", (0, 0), (-1, -1), "TOP"),
]))
story.append(t3)
story.append(sp(1))
# ─────────────────────────────────────────────────────────────────────────
# 12. MDT DISCUSSION & PLAN
# ─────────────────────────────────────────────────────────────────────────
story.append(section_header("12. MDT DISCUSSION & SUMMARY PLAN"))
story.append(sp(0.5))
story.append(Paragraph(
"This case was discussed at the Haematology-Oncology MDT on 18 April 2026. The following "
"consensus management plan was agreed:",
body))
plan_items = [
"Confirm diagnosis — DONE (BM biopsy, FISH, SPEP, IFE, FLC all consistent with IgG-κ MM)",
"Urgent spinal MRI completed — T8 cord impingement identified; neurosurgery alerted",
"Orthopaedic input for T8 kyphoplasty — planned after 2 cycles of induction (tumour debulking first)",
"Nephrology co-management — aggressive IV hydration commenced; monitor for cast nephropathy recovery",
"Initiate D-VRd quadruplet induction (daratumumab + bortezomib + lenalidomide + dexamethasone)",
"Lenalidomide dose adjusted to 10 mg (renal impairment: eGFR 31 mL/min)",
"VZV, PCP, and antifungal prophylaxis commenced",
"Bone protection: zoledronic acid (dose-adjusted) — first infusion after hydration/renal stabilisation",
"Social work referral — home adaptations, pain management, palliative support discussion",
"Patient and family counselled re: diagnosis, high-risk status, treatment goals, and clinical trial options",
"ISRCTN clinical trial eligibility reviewed — patient may qualify for emerging CAR-T or bispecific Ab trial",
"Follow-up: 2 weeks post-cycle 1 for tolerability review + blood tests",
]
for i, item in enumerate(plan_items, 1):
story.append(Paragraph(f"{i}. {item}", bullet))
story.append(sp(1))
# ─────────────────────────────────────────────────────────────────────────
# 13. REFERENCES
# ─────────────────────────────────────────────────────────────────────────
story.append(section_header("13. REFERENCES & EVIDENCE BASE", color=STEEL))
story.append(sp(0.5))
refs = [
("1", "Goldman L, Cooney KA (eds). Goldman-Cecil Medicine, 26th Edition. Elsevier, 2020. "
"Chapter 173: Plasma Cell Disorders (Multiple Myeloma)."),
("2", "Kumar V, Abbas A, Aster J. Robbins & Kumar Basic Pathology, 10th Edition. Elsevier, 2022. "
"Chapter 10: Lymphoid Neoplasms — Multiple Myeloma."),
("3", "Tietz Textbook of Laboratory Medicine, 7th Edition. Elsevier, 2022. Chapter 30: Plasma Cell "
"Disorders and Cytogenetics."),
("4", "Dimopoulos MA, Terpos E, Boccadoro M, et al. EHA-EMN Evidence-Based Guidelines for diagnosis, "
"treatment and follow-up of patients with multiple myeloma. Nat Rev Clin Oncol. 2025 Sep. "
"PMID: 40624367."),
("5", "Avet-Loiseau H, Davies FE, Samur MK, et al. IMS/IMWG Consensus Recommendations on the "
"Definition of High-Risk Multiple Myeloma. J Clin Oncol. 2025 Aug 20. PMID: 40489728."),
("6", "Clarke SE, Fuller KA, Erber WN. Chromosomal defects in multiple myeloma. Blood Rev. "
"2024 Mar. PMID: 38212176."),
("7", "Gay F, Marchetti E, Bertuglia G, et al. Multiple Myeloma Unpacked. Hematol Oncol. "
"2025 Jun. PMID: 40517540."),
("8", "IMWG Diagnostic Criteria for Multiple Myeloma (Updated 2021): Rajkumar SV, et al. "
"International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. "
"Lancet Oncol. 2014;15(12):e538-e548."),
]
ref_tbl_data = [[Paragraph(f"[{n}]", label_style),
Paragraph(text, make_style(f"ref{n}", fontSize=8.5, leading=13, textColor=STEEL))]
for n, text in refs]
ref_tbl = Table(ref_tbl_data, colWidths=[usable*0.07, usable*0.93])
ref_tbl.setStyle(TableStyle([
("VALIGN", (0, 0), (-1, -1), "TOP"),
("TOPPADDING", (0, 0), (-1, -1), 3),
("BOTTOMPADDING", (0, 0), (-1, -1), 3),
("LEFTPADDING", (0, 0), (-1, -1), 4),
]))
story.append(ref_tbl)
story.append(sp(1.5))
# Final disclaimer
story.append(HRFlowable(width="100%", thickness=0.5, color=BORDER_GREY))
story.append(sp(0.5))
story.append(Paragraph(
"DISCLAIMER: This document is an illustrative clinical case report for a de-identified / unknown patient, "
"created for educational purposes only. Drug doses, laboratory values, and clinical details have been "
"constructed to represent a typical high-risk Multiple Myeloma presentation in alignment with published "
"guidelines. This document does not constitute medical advice and must not be used to guide real patient "
"care without independent clinical assessment by a qualified haematologist. Report generated by Orris "
"Medical AI — 01 June 2026.",
disclaimer))
# ─────────────────────────────────────────────────────────────────────────
# BUILD
# ─────────────────────────────────────────────────────────────────────────
doc.build(story, onFirstPage=on_page, onLaterPages=on_page)
print(f"PDF saved to: {OUTPUT}")
build()
Running Command
cd /home/daytona/workspace/blood-cancer-report && python generate_report.py 2>&1
Running Command
ls -lh /home/daytona/workspace/blood-cancer-report/Multiple_Myeloma_Clinical_Case_Report.pdf
The report is ready. Here's your download link:
Multiple Myeloma Clinical Case Report
PDF Document · PDF
What's in the Report
This is a fully structured, 4-page clinical case report for a de-identified 67-year-old male with IgG-κ Multiple Myeloma (ISS Stage III / R-ISS Stage III / High-Risk cytogenetics). It includes:
| Section | Contents |
|---|---|
| Patient Demographics | Age, sex, ethnicity, admission info, referral source |
| Chief Complaint & History | 8-month symptom timeline from back pain to fracture |
| Past Medical History | HTN, T2DM, prior MGUS, osteoporosis, allergies |
| Physical Examination | Vital signs table + system-by-system findings |
| Lab Investigations | CBC, metabolic panel, full myeloma-specific panel (SPEP, IFE, FLC, κ/λ ratio, Bence Jones) with colour-coded flagging |
| Bone Marrow Biopsy | 38% plasma cells, CD138+/CD38+, FISH: t(4;14) + del(17p) - high risk |
| Imaging | WBLDCT lytic lesions, MRI spine T8 fracture, PET-CT, echo, renal USS |
| Diagnosis & Staging | IMWG criteria, ISS III, R-ISS III with rationale |
| Pathophysiology | RANKL/OPG axis, IL-6, TP53 deletion, renal cast nephropathy |
| Treatment Plan | D-VRd quadruplet induction + ASCT + lenalidomide maintenance + full supportive care table |
| Prognosis & Monitoring | Response criteria, MRD targets, surveillance schedule |
| MDT Plan | 12-point consensus management plan |
| References | 8 sources including EHA-EMN 2025 guidelines and IMWG 2025 consensus (PMID cited) |
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