[MMSunny]

Change in treatment due to side effects - good idea?

by MMSunny on Thu Feb 13, 2014 1:04 pm

I had a relapsed myeloma and found out today that that my myeloma is in remission!

My doctors are suggesting a different medication due to side effects and intolerance I showed for lenalidomide [Revlimid]. Side effects from lenalidomide for me included drop in white blood counts (3 instances, which caused infection and was in supportive care for 10 days), blood clot in leg (treatment underway), vertigo and neuropathy.

I am being recommended 3 cycles of liposomal doxorubicin [Doxil] + dexamethasone + low molecular weight heparin.

I am very weak now. Can I wait for couple of months before I resume the treatment, now that I am in remission?

Can I go in for a low dose of lenalidomide instead of changing the treatment option?

Your opinion and support always matters to me.

Regards

Sunny

[Dr. Ken Shain]

Re: Change in treatment due to side effects - good idea?

by Dr. Ken Shain on Fri Feb 14, 2014 10:25 am

Every oncologist has the right to their own opinion in regards to therapy. However, if you have not been dose-reduced previously and have a response to the extent you have stated (I do not know what remission means), then starting up a lower dose of Revlimid makes the most sense to me. Individuals can be on doses down to 5mg for days 1-21 of a 28-day cycle.

My recommendation would be to appropriately manage your deep vein thrombosis (the clot that led to treatment with low molecular weight heparin) and, once you are stable and your counts have recovered, to continue on a lower dose of Revlimid with careful monitoring of your counts. However, this is a decision between you and your oncologist.

[stann]

Re: Change in treatment due to side effects - good idea?

by stann on Fri Feb 14, 2014 11:35 am

How long have you been in "remission"? I'm assuming you mean undetected levels of "bad stuff". So your doctor has you on maintenance therapy?
I was on maintenance for 2 years and my multiple myeloma specialist said it was a 50/50 decision on whether to continue on low dose Rev (5mg) or to stop altogether.
A year ago, he suggested staying on it until it no longer worked. But studies released in the last year, pushed that decision more towards stopping maintenance after 2 years, especially if I was having side effects from the Revlimid.

[MMSunny]

Re: Change in treatment due to side effects - good idea?

by MMSunny on Fri Feb 14, 2014 2:13 pm

Thanks Dr Ken Shain,
By remission I meant my BMA report after 3rd cycle showed plasma at 7%. I am told that I responded very good to Lenolidimide but could not tolerate the toxicity. But I agree with you, Low dose of Lenolidimide [Revlimid] was the second option suggested and I make take that up.

Would it make sense to go from 25 mg to 15 mg and then if there are side effects then go down to 5 mg? Or Can I just directly jump to 5 mg?
Is this for 2 years or forever (based on some new study results)

Is dexamethasone also recommended along with this?

Appreciate the response means a lot to get response from you.

Regards and thanks

Sunny

[MMSunny]

Re: Change in treatment due to side effects - good idea?

by MMSunny on Fri Feb 14, 2014 2:21 pm

Hi Stann… I finished my 3 cycles last week and my BMA showed 7% Plasma, I am being told to get another 2-3 cycles of Revlimid + dexamethasone. How many cycles of Revlimid 25mg did you go through before getting into low dose maintenance therapy?

thanks for responding
Sunny