[Ulla, DK]

Advice re relapse

by Ulla, DK on Mon Nov 19, 2012 7:41 am

Hi,

I have been reading the Myeloma Beacon for a while and it has been extraordinarily informative and a great help in understanding this terrible disease.

My husband was diagnosed with multiple myeloma in August 2010 at 52 years old. In January 2011 he did an autologous transplant. When he was diagnosed his m-protein was about 40. After the transplant it was undetectable. Unfortunately he already relapsed in August/September 2011. He was then treated with Thalidomide but it didn’t have any effect, then with Velcade, Cyclophosphamide and Dexamethasone and after 8 cycles his m-protein dropped to 2. After two month off treatment he relapsed again in June 2012. He was then put on Revlimid (25 mg) and Dexamethasone (40 mg), which he is still on. After the third cycle his m-protein was 9 and he had a partial response. He has had 5 cycles by now. Dexamethasone was reduced in the fifth cycle so that he only took it the first four days. After the fourth cycle his m-protein rise to 11 and now after the fifth cycle it is 14. When he relapsed the first time after the transplant and the second time after being treated with Cyclophosphamide, Velcade and Dexamethasone, his m-protein doubled in a month time and he was having collapsed vertebras. Now his m-protein is rising more slowly and he is not having any back pain. We are trying to figure out our best options from here and hope that someone would be able to provide us with some help. My question is: Does Revlimid still seem to be working to some degree? Do you think we should watch and wait or should they add another agent or start another therapy right away? Is there any particular regimen or agent that you would suggest?

Thank you very much in advance. Your help is much appreciated!

[Dr. Jason Valent]

Re: Advice re relapse

by Dr. Jason Valent on Mon Nov 19, 2012 6:58 pm

Since he did not relapse while taking a Velcade based regimen, I think restarting a Velcade based regimen is the best option. He may not need the cytoxan. If it works, then Velcade can be continued on a maintenance basis every other week after 4-6 months of Velcade and dexamethasone. The Velcade and dex can be weekly or 3 weeks on and one week off.

[Ulla, DK]

Re: Advice re relapse

by Ulla, DK on Fri Nov 23, 2012 8:10 am

Thank you for your opinion Dr. Valent. It is very helpful!