When I was first diagnosed, I was put on Rev/Dx which dropped my Mspike from 5.5 to 3.0. Then Velcade was added and after 3 months of Rev/Dx/Velcade, my mspike was still 3.0--no effect.
Since then I've had tandem transplants and now am down to 0.4.
Doctor wants to put me back on Rev/Dx/Velcade to try and get me into Complete Remission.
When I reminded him of my "no response" a couple of years ago, he said that this mix will often be more effective when numbers are low rather than high, so thinks we should give it another try.
Does this make sense?
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Re: Are multiple myeloma cells more sensitive to chemo after
Hi Stann,
I too would like to know the answer to this question. My M-spike was 4.4 or higher when I started treatment with Rev/Dex it dropped a little after 2 cycles, then I went on 2 cycles of RVD and it dropped a little, now I am on Cyclophosomide Velcade and Dex and it dropped a little and is now staying at 3.1. At least the m-spike has not gone back up. My doctor is scheduling me for a autogulous stem cell transplant. I will get high dose chemo first to get my m-spike down. What high dose chemo treatment did you use prior to stem cell collection? Will these drugs that didn't work for us before SCT or worked minimally work better for us after SCT?
Best of luck to you Stann!
I too would like to know the answer to this question. My M-spike was 4.4 or higher when I started treatment with Rev/Dex it dropped a little after 2 cycles, then I went on 2 cycles of RVD and it dropped a little, now I am on Cyclophosomide Velcade and Dex and it dropped a little and is now staying at 3.1. At least the m-spike has not gone back up. My doctor is scheduling me for a autogulous stem cell transplant. I will get high dose chemo first to get my m-spike down. What high dose chemo treatment did you use prior to stem cell collection? Will these drugs that didn't work for us before SCT or worked minimally work better for us after SCT?
Best of luck to you Stann!
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Michelle - Name: Michelle
- When were you/they diagnosed?: 2009
- Age at diagnosis: 53
Re: Are multiple myeloma cells more sensitive to chemo after
There's not a huge amount of data to answer this question, but yes, sometimes after high-dose melphalan and SCT we can see patients regain sensitivity to previously-used therapies. It may be related to the disruption of the bone marrow microenvironment from the high-dose chemo that makes the myeloma cells more sensitive to the post-transplant treatments.
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Dr. Adam Cohen - Name: Adam D. Cohen, M.D.
Beacon Medical Advisor
Re: Are multiple myeloma cells more sensitive to chemo after
Dr Cohen--thank you.
Michelle,
I'm not sure if I'm answering your question, but I didn't have high dose chemo prior to collection. Just a few rounds of Revlimid, Velcade and Dex.
And immediately before transplant I had melphalan, which is standard. Good luck with your transplant. I think most people find them to not be as unpleasant as they anticipate. Just hope your hospital has more channels on the tv than mine had.
Michelle,
I'm not sure if I'm answering your question, but I didn't have high dose chemo prior to collection. Just a few rounds of Revlimid, Velcade and Dex.
And immediately before transplant I had melphalan, which is standard. Good luck with your transplant. I think most people find them to not be as unpleasant as they anticipate. Just hope your hospital has more channels on the tv than mine had.
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Stann
Re: Are multiple myeloma cells more sensitive to chemo after
I am cannot say exactly what you oncologist is suggesting with high-dose therapy prior to collection, Michelle. I usually consider high-dose therapy with melphalan as the consolidation part of the transplant processs. In fact, it is the autologous stem cell transplant that supports our ability to give you high does melphalan. If we did not collect your cells and give them back, your recovery from the high-dose melphalan would be very difficult.
That being said, your oncologist may be planning an inpatient multiple agent regimen of chemotherapy like DCEP or CVAD to get a better response (in some cases MDs can utilize even more agents in combination (for example, VTD-PACE, which combines novel and traditional agents). These all represent relatively "high-dose" therapy relative to what you have already expericenced, hence the requirement for inpatient treatment. But unlike high-dose melphalan these do not require stem cell rescue.
These combination regimens are often uused to obtain better responses in cases of relatively unresponsive disease. We like to have at least a PR (partial respone: >50% reduction in disease burden) prior to transplant. However, it is important to note that this is not a requirement unless you are a Medicare patient.
With less than a PR, we we are more likely to suggest tandem transplantation.
If this does not clarify things please let me know and I can give you more details.
That being said, your oncologist may be planning an inpatient multiple agent regimen of chemotherapy like DCEP or CVAD to get a better response (in some cases MDs can utilize even more agents in combination (for example, VTD-PACE, which combines novel and traditional agents). These all represent relatively "high-dose" therapy relative to what you have already expericenced, hence the requirement for inpatient treatment. But unlike high-dose melphalan these do not require stem cell rescue.
These combination regimens are often uused to obtain better responses in cases of relatively unresponsive disease. We like to have at least a PR (partial respone: >50% reduction in disease burden) prior to transplant. However, it is important to note that this is not a requirement unless you are a Medicare patient.
With less than a PR, we we are more likely to suggest tandem transplantation.
If this does not clarify things please let me know and I can give you more details.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Are multiple myeloma cells more sensitive to chemo after
Thank you Dr. Shain and Stann for your replies. It looks like I will need to get some of the high dose treatments you suggested such as CVAD or one of the other ones to get my m protein down before I can collect my stem cells collected. I really appreciate your responses. If I need a tandem transplant then that's what I'll do. The good thing is my m protein is not going up.
Thanks again!
Michelle
Thanks again!
Michelle
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Michelle - Name: Michelle
- When were you/they diagnosed?: 2009
- Age at diagnosis: 53
6 posts
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