[Villa fan]

Paul's VD-PACE treatment experience

by Villa fan on Thu Sep 11, 2014 12:21 am

I'm now on Day 3 of VD-PACE and very happy that I chose the outpatient option at UCSF. Side effects for me so far have been only mild nausea and reflux, which are managed well with Zofran (ondansetron) and Pepcid (famotidine). I have gained about 4 lbs (2 kg) over the last 3 days, which could be fluid retention, although there are no outward signs like swollen joints. I take lorazepam (Ativan) at night for more protection against nausea and to help me sleep on the high dose dex (40 mg).

Otherwise I feel fine and would have been going nuts in hospital.

I've been taking the anti-nausea drugs when I felt I needed them, but was advised today to take them 'round the clock'. Apparently, about 3 days is when the side effects kick in. Cisplatin can cause abnormal magnesium levels, which are being checked tomorrow.

I'm doing this as one 4-day cycle in preparation for stem cell collection and then ASCT. So my regimen may be different from someone on VD-PACE for longer.

I'm carrying around 2 infusion pumps and two bags of chemo. One has doxorubicin (Adriamycin) (19 mg in 120 ml) and the other has cisplatin (19 mg) plus cyclophosphamide (770 mg) plus etoposide (77 mg) in a total volume of 1112 ml. It's a 24 hour continuous IV infusion through a PICC line that was implanted on Monday under local anesthetic and sterile surgery techniques. That procedure took about 30 mins and was no big deal given the gazillions of other needle sticks I've had in the last 6 months!

I hope this is helpful and can post another update if / when anything significant happens.

[Multibilly]

Re: Paul's VD-PACE treatment experience

by Multibilly on Thu Sep 11, 2014 7:51 am

Paul,

Thanks for sharing this journey.

I'm still trying to piece together your history here. It sounds like there was an overall plan from the beginning to start you on RVD and then move you to VD-PACE in prep for an ASCT, right? Was the thinking that this two-stage regimen would get you to as deep as response as possible going into the ASCT? Is there some reason that the doctors thought that you wouldn't get to a deep response on just RVD or VD-PACE alone?

[Villa fan]

Re: Paul's VD-PACE treatment experience

by Villa fan on Thu Sep 11, 2014 10:45 pm

I started treatment with one cycle of Revlimid / dex, which had little effect. We then added Velcade for a total of 6 cycles of RVD. After 4 cycles, my plasma cells in my bone marrow were down from 65% to 15%. The doctor wanted to try to push this lower with another couple of cycles of RVD. But my plasma cells remained at 15%, although my IgG is now comfortably in normal range and M-spike is 0.5 g/dL, down from 4.3 g/dL at the beginning.

So he decided to do this one cycle of VD-PACE to drive down the numbers as much as possible before ASCT.

I now have my final bags of chemo, which finishes tomorrow. And I'm done with dex thank goodness! I am getting more nausea now, which is quite well controlled by the anti-nausea drugs.

Tomorrow I learn how to self inject Neupogen and will start taking antibiotics and antifungals to prevent infections as my cell counts start to drop next week from the chemo.

[Multibilly]

Re: Paul's VD-PACE treatment experience

by Multibilly on Fri Sep 12, 2014 8:08 am

Thanks for the update Paul. If I were doing a transplant, I'd be fighting like hell to get as deep a response as I could prior to HD-ASCT. Glad to hear your doc considered this as the next step.

When will you know your numbers as a result of the VD-PACE cycle?

[Villa fan]

Re: Paul's VD-PACE treatment experience

by Villa fan on Fri Sep 12, 2014 10:10 pm

Blood draw on Monday, but this is to monitor blood cell counts. Don't think we're measuring multiple myeloma markers until maybe end of next week.