My daughter starts chemo infusions today for her multiple myeloma after relapsing from induction therapy, stem cell transplant and Revlimid.
When I was changing my insulin pump (which I have worn for 18 years) this morning, I thought, wouldn't it be easier for those needing chemo if they could hook up a pump and give their own infusion. If they got the chemo 2 days in a row, they could leave it on in suspension mode till the next day when they infuse again.
The logistics would have to be figured out and I don't know the technical difficulties But it would save time, probably money, and enable patients to lead more of their normal life.
I realize most chemo is delivered through a vein and with an insulin pump it is not, but it might work with Velcade now that they are giving that as a shot.
It was just a thought on how to make things easier for chemo patients.
Forums
Re: Why not use a pump to administer myeloma therapies?
Well, I can think of a few...reasons you wouldn't want to force toxic and tissue irritating chemicals in MY Veins/ Arteries.
Look up Bolus injections and the contraindications for use,...IntraMuscular; IntraVenous; Arterial; etc.
Chemo drugs are notoriously harsh on tissue. ie. Mephalan is derived from Mustard gas: (See, WWI )
_ _ _ _ _ _ _ _ _ _ _ _
Vessel /skin damage--
Air embolism --(Usually fatal without direct medical care)
Clotting--( See, above)
Extravasation into tissues--( I have really gorey photos of tissue destruction/necrosis /damage )
Infection-- (Injection site) (see, above)
Blown veins, Subcutaneous abcesses, Neuromas, nerve injuries, etc--( Need more ?)
Contamination.
Velcade --when given as an injection (ie. 1.3 mg/l Sub-Q) , is given by an RN /PA /MD as a slow injection--with direct observation of the site--to look for the above. A Vein is not used. Many patients just can't see the injection site adequately.
The nice thing about micro infusers used in Diabetes and Pre-natal patients--is that the medications are NOT Toxic...and PH balanced, usually.
Good luck to your daughter.
Look up Bolus injections and the contraindications for use,...IntraMuscular; IntraVenous; Arterial; etc.
Chemo drugs are notoriously harsh on tissue. ie. Mephalan is derived from Mustard gas: (See, WWI )
_ _ _ _ _ _ _ _ _ _ _ _
Vessel /skin damage--
Air embolism --(Usually fatal without direct medical care)
Clotting--( See, above)
Extravasation into tissues--( I have really gorey photos of tissue destruction/necrosis /damage )
Infection-- (Injection site) (see, above)
Blown veins, Subcutaneous abcesses, Neuromas, nerve injuries, etc--( Need more ?)
Contamination.
Velcade --when given as an injection (ie. 1.3 mg/l Sub-Q) , is given by an RN /PA /MD as a slow injection--with direct observation of the site--to look for the above. A Vein is not used. Many patients just can't see the injection site adequately.
The nice thing about micro infusers used in Diabetes and Pre-natal patients--is that the medications are NOT Toxic...and PH balanced, usually.
Good luck to your daughter.
-
Rneb
Re: Why not use a pump to administer myeloma therapies?
Rneb had some good reasons not to use a pump. In addition to those, the main reason I wouldn't want to wear a pump is that I don't want to have to deal with something that I have to care for on a daily basis that could be a potential cause of a new infection. To me it would me more hassle than it would be worth.
When I had my initial treatment, I had one Velcade shot a week and I could easily handle that because it was just one shot in my stomach. All the other "chemo" I had was by taking pills.
When I had my initial treatment, I had one Velcade shot a week and I could easily handle that because it was just one shot in my stomach. All the other "chemo" I had was by taking pills.
-
DallasGG - Name: Kent
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 6/20/2013
- Age at diagnosis: 56
Re: Why not use a pump to administer myeloma therapies?
Well, I know of at least one person on this site that does do their own subq (subcutaneous) Velcade injections. As a result of this revelation, I have already discussed the idea of doing my own subq Velcade shots (should I ever need treatment) with my onc and he sees no issue with it, as long as I get trained by the nurses on the correct procedure.
Now, obviously, this won't work with other chemo drugs that require an IV. I also believe that when you get IV treatment, that the facility actually mixes up the chemo for the patient that same day.
I got interested in this subq Velcade option simply because I want the flexibility to travel for weeks at a time. I'm sure that there are also cost-savings to be gained with this approach, although that wasn't my main concern.
Now, obviously, this won't work with other chemo drugs that require an IV. I also believe that when you get IV treatment, that the facility actually mixes up the chemo for the patient that same day.
I got interested in this subq Velcade option simply because I want the flexibility to travel for weeks at a time. I'm sure that there are also cost-savings to be gained with this approach, although that wasn't my main concern.
Last edited by Multibilly on Thu Aug 14, 2014 6:37 pm, edited 1 time in total.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Why not use a pump to administer myeloma therapies?
Hi TJ13,
I will be showing my age here, but when I was diagnosed a very long time ago, I was treated with the old VAD treatment that consisted of 4 days continuous infusion of vincristine, Adriamycin (doxorubicin) and 40 mg / day dex pills. The thinking in those days was that, since myeloma is a slow growing disease (a myeloma cell might divide once in 4 days) and the cells are more / only sensitive to these chemotherapy while dividing, that a longer time period allows more cells to respond to the treatment.
The pump was about the size of a large cell phone and connected to my old "under the skin" port-a-cath. I wore it like we wear cell phones today. It was on a hook on my belt. I could walk around while getting treatment and even went into work everyday. The total amount of drug I got was higher, but it never got to high levels like with today's infusions, so I never had side effects like tiredness or hair loss. I think it was considered "dense" therapy, not high dose therapy like before an ASCT.
My point is that your thinking is reasonable, convenient, and was totally doable even with 1980's technologies. This thinking is out of vogue today with the new targeted therapies that attack cells that produce large amount of proteins (i.e. antibodies), but could make a comeback if they start combining those old drugs with the new ones for relapsed / resistant disease.
Anyway, just me 2 cents. I hope your daughter responds well to her new treatment and gets back into remission for a long, long time.
All my best,
Dan
I will be showing my age here, but when I was diagnosed a very long time ago, I was treated with the old VAD treatment that consisted of 4 days continuous infusion of vincristine, Adriamycin (doxorubicin) and 40 mg / day dex pills. The thinking in those days was that, since myeloma is a slow growing disease (a myeloma cell might divide once in 4 days) and the cells are more / only sensitive to these chemotherapy while dividing, that a longer time period allows more cells to respond to the treatment.
The pump was about the size of a large cell phone and connected to my old "under the skin" port-a-cath. I wore it like we wear cell phones today. It was on a hook on my belt. I could walk around while getting treatment and even went into work everyday. The total amount of drug I got was higher, but it never got to high levels like with today's infusions, so I never had side effects like tiredness or hair loss. I think it was considered "dense" therapy, not high dose therapy like before an ASCT.
My point is that your thinking is reasonable, convenient, and was totally doable even with 1980's technologies. This thinking is out of vogue today with the new targeted therapies that attack cells that produce large amount of proteins (i.e. antibodies), but could make a comeback if they start combining those old drugs with the new ones for relapsed / resistant disease.
Anyway, just me 2 cents. I hope your daughter responds well to her new treatment and gets back into remission for a long, long time.
All my best,
Dan
-
Dan in Phoenix
Re: Why not use a pump to administer myeloma therapies?
Another thing I'm wondering about here is the pre-treatment CBC tests that I always got before my Velcade injections or infusions. It's important to make sure that CBC numbers are ok before Velcade administration, and my assumption is that a trained medical professional would be the one to look at the results and make a go/no-go decision.
Multibilly, that's not an issue with your medical team if you end up using Velcade? (Or maybe you ARE a trained medical professional, which I would not doubt based on the high quality of your many posts!)
Multibilly, that's not an issue with your medical team if you end up using Velcade? (Or maybe you ARE a trained medical professional, which I would not doubt based on the high quality of your many posts!)
-
mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: Why not use a pump to administer myeloma therapies?
MikeB,
Obviously, I'm not a trained medical professional. But, do you get a CBC before each and every Velcade injection, or just as part of your ongoing monitoring every few weeks or months? If the latter, then my doc would be weighing in on whether to continue and/or adjust the injection doses.
Now, I want to also be clear that this conversation with my onc lasted all of one minute and was completely hypothetical since I am currently only smoldering. So, I don't want to oversimplify the situation here and I want to be clear that we did not get into the specifics of how this would really work in practice.
But for me personally, the idea of being able to completely avoid going into a facility every week for injections would be a major game changer (this is probably the one logistical thing I dread most about becoming symptomatic, given my continued desire to travel and backpack throughout the world at long stretches at a time ... till the day I move on). This is also a reason why I'm keenly interested in new oral PI drugs like ixazomib that are currently being tested on newly diagnosed multiple myeloma patients (in phase 3 trial now) and in relapsed / refractory patients.
Perhaps Derek (Coop) might shed some more light on his self-administered Velcade experience?
https://myelomabeacon.org/forum/velcade-t1921-10.html
Obviously, I'm not a trained medical professional. But, do you get a CBC before each and every Velcade injection, or just as part of your ongoing monitoring every few weeks or months? If the latter, then my doc would be weighing in on whether to continue and/or adjust the injection doses.
Now, I want to also be clear that this conversation with my onc lasted all of one minute and was completely hypothetical since I am currently only smoldering. So, I don't want to oversimplify the situation here and I want to be clear that we did not get into the specifics of how this would really work in practice.
But for me personally, the idea of being able to completely avoid going into a facility every week for injections would be a major game changer (this is probably the one logistical thing I dread most about becoming symptomatic, given my continued desire to travel and backpack throughout the world at long stretches at a time ... till the day I move on). This is also a reason why I'm keenly interested in new oral PI drugs like ixazomib that are currently being tested on newly diagnosed multiple myeloma patients (in phase 3 trial now) and in relapsed / refractory patients.
Perhaps Derek (Coop) might shed some more light on his self-administered Velcade experience?
https://myelomabeacon.org/forum/velcade-t1921-10.html
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Why not use a pump to administer myeloma therapies?
I don't think that Velcade could be used on a pump such as suggested by TJ13, since it is a drug that is only mixed and administered right before the time of infusion or injection.
My dosage was individualized and calculated by a formula of height and weight, and there was a small amount of time between mixing the Velcade and injecting it (I had it by infusion, before sub-Q was available), since it is a biological type of drug and has to be stored as such. It is also very expensive and thus would not be pre-mixed for a patient until the 'stat' blood work was available, since they would not want to waste any of it, were the patient not able to have a dosage that day! (That could be the case if one's blood work showed neutropenia or other problems).
Probably any orally takes meds such as thalidomide, Revlimid, or Pomalyst are the most convenient in terms of not having to go to a cancer centre. Even so, one's blood results are tested between cycles of the drug (i.e. once a month). It's an interesting consideration for us patients. Also, when one is taking Velcade or other infusible drug, a 'port' might be used, or else needle injections every time. That is why the 'sub-Q' injections are also more convenient.
My dosage was individualized and calculated by a formula of height and weight, and there was a small amount of time between mixing the Velcade and injecting it (I had it by infusion, before sub-Q was available), since it is a biological type of drug and has to be stored as such. It is also very expensive and thus would not be pre-mixed for a patient until the 'stat' blood work was available, since they would not want to waste any of it, were the patient not able to have a dosage that day! (That could be the case if one's blood work showed neutropenia or other problems).
Probably any orally takes meds such as thalidomide, Revlimid, or Pomalyst are the most convenient in terms of not having to go to a cancer centre. Even so, one's blood results are tested between cycles of the drug (i.e. once a month). It's an interesting consideration for us patients. Also, when one is taking Velcade or other infusible drug, a 'port' might be used, or else needle injections every time. That is why the 'sub-Q' injections are also more convenient.
-
Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Why not use a pump to administer myeloma therapies?
Hi Multibilly,
I am not getting Velcade now, but when I did get it, they did the CBC check before each administration. I completely understand your concern about traveling into a facility for each treatment. When I was getting Velcade, I made the 2-hour one-way train / subway / walking trip to the facility twice a week. It did eat up a lot of time.
I could have gotten the Velcade administered at a closer facility by my local oncologist instead of by my myeloma specialist, except that I am in a clinical trial, so they need to do everything at the specialist's facility. It was a tradeoff I was / am willing to make, though. Fortunately, now that I am on Revlimid maintenance, I only need to make that trip once a month.
Nancy made a good point about the need to mix the Velcade right before it is administered. I'd forgotten about that.
Derek's self-administration experience is very interesting! Obviously that flies in the face of what I've said, so maybe there are ways around the issues we've been discussing. Life sure would be easier for many people taking Velcade with self-administration.
It only took a couple of shots for me to get over being a little squeamish about injecting Neupogen into my thighs prior to my stem cell collection. So I imagine injecting Velcade would be similar.
I am not getting Velcade now, but when I did get it, they did the CBC check before each administration. I completely understand your concern about traveling into a facility for each treatment. When I was getting Velcade, I made the 2-hour one-way train / subway / walking trip to the facility twice a week. It did eat up a lot of time.
I could have gotten the Velcade administered at a closer facility by my local oncologist instead of by my myeloma specialist, except that I am in a clinical trial, so they need to do everything at the specialist's facility. It was a tradeoff I was / am willing to make, though. Fortunately, now that I am on Revlimid maintenance, I only need to make that trip once a month.
Nancy made a good point about the need to mix the Velcade right before it is administered. I'd forgotten about that.
Derek's self-administration experience is very interesting! Obviously that flies in the face of what I've said, so maybe there are ways around the issues we've been discussing. Life sure would be easier for many people taking Velcade with self-administration.
It only took a couple of shots for me to get over being a little squeamish about injecting Neupogen into my thighs prior to my stem cell collection. So I imagine injecting Velcade would be similar.
-
mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: Why not use a pump to administer myeloma therapies?
I also had an infusion pump when I was on VAD. Was very convenient.
-
Cheryll
11 posts
• Page 1 of 2 • 1, 2
Return to Treatments & Side Effects