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Chemo ineffective... Now what?
My Dad was diagnosed with a rare, aggressive form of multiple myeloma 2 months ago. He has has not quite two full rounds of chemo when he began getting fevers. Not overly high, but disorienting and concerning enough to hospitalize him and run SEVERAL tests and scans all coming up negative. He is on his second round of antibiotics, this time a stronger dose to abolish whatever infection is thought to be causing the fevers. They come on routinely every evening after 5 pm and last into the night. They are gone by morning. Since the onset of the fevers he is confused at times, and his speech has slowed right down. He has slowed down in general. Rapidly. A different person in a span of 2 weeks. Every day is a decline. A bone marrow biopsy done yesterday has proven the chemo to be ineffective and that the cancer has spread to his platelets. He was a candidate for a stem cell transplant, but now we are stuck... His oncologist is away until next week and we are not getting any answers. Has anyone had this experience? Wondering if we need to go to another hospital?
Re: Chemo ineffective... Now what?
Dear Rystik,
Can you provide some additional information? How old is your father? Can you clarify what you mean by rare aggressive form of myeloma -- plasma cell leukemia? Lastly, what treatment has been used for the last 2 months?
Thanks!
Pete V.
Can you provide some additional information? How old is your father? Can you clarify what you mean by rare aggressive form of myeloma -- plasma cell leukemia? Lastly, what treatment has been used for the last 2 months?
Thanks!
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Chemo ineffective... Now what?
Hello Dr. Voorhees
Thank you for your prompt reply. My dad is 63 years old. He is very physically fit and strong. Always hiking physically active. 2 years ago he was diagnosed with prostate cancer. He had radiation seeds implanted and that seems to have resolved that issue. Last fall he began to notice lower stamina and shortness of breath. In April he was diagnosed with Anaplastic Myeloma in his bone marrow. He began treatment with cyclophosphamide pills and bortezomib injections along with hydromorphone, allopurinol, valacyclovir, metoclopramide, dexamethazone steroid, rabeprazole, pamidronate and tamsulosin (from the prostate side effects).
He had one full first round of chemo,then 3/4 of the second round when the fevers began. Until this point the plan was to have 2 more rounds of chemo ( 4 treatments) then have a stem cell transplant. Now it's been nearly 3 weeks with the fevers appearing every day around 4:00 pm and lasting into the night. He is on Moxiflaxacin 400 mg for 10 days. Today is the 10th day. All blood tests, CT scans and other tests are negative. There has been a second bone marrow biopsy done and while the written report hasn't been finalized, the attending doctor has verbally told us its now reducing his platelet count (when previously it was just his red and white blood cells). Therefore the chemo isn't doing what they'd hoped.
We are feeling like our hands are tied. His oncologist is away until next week. Do you know of other treatments? We had heard of thalidomide being perhaps an option, but that hasn't been presented to us. He wants to leave the hospital, but I feel like if we take him home, it's a lost cause.
Is all happened so quickly and he's deteriorated so fast it's all just really hard to accept that it's all we can do. There has got to be another answer.
Any insight would be greatly appreciated.
Thank you for your thoughts.
Thank you for your prompt reply. My dad is 63 years old. He is very physically fit and strong. Always hiking physically active. 2 years ago he was diagnosed with prostate cancer. He had radiation seeds implanted and that seems to have resolved that issue. Last fall he began to notice lower stamina and shortness of breath. In April he was diagnosed with Anaplastic Myeloma in his bone marrow. He began treatment with cyclophosphamide pills and bortezomib injections along with hydromorphone, allopurinol, valacyclovir, metoclopramide, dexamethazone steroid, rabeprazole, pamidronate and tamsulosin (from the prostate side effects).
He had one full first round of chemo,then 3/4 of the second round when the fevers began. Until this point the plan was to have 2 more rounds of chemo ( 4 treatments) then have a stem cell transplant. Now it's been nearly 3 weeks with the fevers appearing every day around 4:00 pm and lasting into the night. He is on Moxiflaxacin 400 mg for 10 days. Today is the 10th day. All blood tests, CT scans and other tests are negative. There has been a second bone marrow biopsy done and while the written report hasn't been finalized, the attending doctor has verbally told us its now reducing his platelet count (when previously it was just his red and white blood cells). Therefore the chemo isn't doing what they'd hoped.
We are feeling like our hands are tied. His oncologist is away until next week. Do you know of other treatments? We had heard of thalidomide being perhaps an option, but that hasn't been presented to us. He wants to leave the hospital, but I feel like if we take him home, it's a lost cause.
Is all happened so quickly and he's deteriorated so fast it's all just really hard to accept that it's all we can do. There has got to be another answer.
Any insight would be greatly appreciated.
Thank you for your thoughts.
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Anonymous
Re: Chemo ineffective... Now what?
I am sorry to hear that things are not going well. Assuming that the cyclophosphamide, bortezomib (Velcade) and dexamethasone were given at standard doses, the fact that the myeloma is progressing through the second cycle of treatment is highly concerning. I would not be surprised if the myeloma was responsible for the fevers.
I do not think that thalidomide alone or with dexamethasone would be enough here. In instances where the disease is behaving this aggressively, we will often consider the possibility of a multidrug, infusional chemotherapy approach, for example, VDT-PACE (bortezomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophophosphamide, etoposide). However, this is not easy at all, especially if someone is really sick going into the treatment. It requires prophylactic antibiotics and frequent lab checks to determine if red cell and/or platelet transfusions are needed. If the kidneys are not working well, the doses of some of the medications may need to be adjusted. Another less intensive approach would be a combination of carfilzomib, Revlimid and dexamethasone.
I hope things turn around for your father. Hang in there!
Pete V.
I do not think that thalidomide alone or with dexamethasone would be enough here. In instances where the disease is behaving this aggressively, we will often consider the possibility of a multidrug, infusional chemotherapy approach, for example, VDT-PACE (bortezomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophophosphamide, etoposide). However, this is not easy at all, especially if someone is really sick going into the treatment. It requires prophylactic antibiotics and frequent lab checks to determine if red cell and/or platelet transfusions are needed. If the kidneys are not working well, the doses of some of the medications may need to be adjusted. Another less intensive approach would be a combination of carfilzomib, Revlimid and dexamethasone.
I hope things turn around for your father. Hang in there!
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Chemo ineffective... Now what?
Thank you so much for your information. The results of the latest bone marrow test show an increase in infected plasma cells from 82% to 88% confirming that the chemo recieved thus far hasn't worked. (And yes, to answer your previous question, it was standard doses). Interestingly, he hasn't had a fever in 3 days. (He has had fevers daily for more than 2 weeks). Also, his hemoglobin, is the highest it's been in weeks - 101. His platelets and white blood cells are still quite low, but on the rise. All good news, despite the poor prognosis from the bone marrow biopsy last week.
The new plan is to administer high doses of dexamethazone all week to build up his strength enough to transfer him from a general hospital in his area, to a Cancer Center in a nearby major center. There, they will give him very high doses of cyclophophosphamide to prepare him for stem cell transplant.
We are hoping that he will be strong enough to handle the new chemotherapy regimen, as it will have to be done as an outpatient. He has been gaining a little more strength each day (in the past 3 days) so we are hopeful.
The fact that he is still a candidate for a transplant is such good news... though we are definitely conscious that this will be a long road ahead.
He is actually being discharged tomorrow so that he can go home for a night before heading to the city in preparation for the new treatment.
Fingers crossed!
The new plan is to administer high doses of dexamethazone all week to build up his strength enough to transfer him from a general hospital in his area, to a Cancer Center in a nearby major center. There, they will give him very high doses of cyclophophosphamide to prepare him for stem cell transplant.
We are hoping that he will be strong enough to handle the new chemotherapy regimen, as it will have to be done as an outpatient. He has been gaining a little more strength each day (in the past 3 days) so we are hopeful.
The fact that he is still a candidate for a transplant is such good news... though we are definitely conscious that this will be a long road ahead.
He is actually being discharged tomorrow so that he can go home for a night before heading to the city in preparation for the new treatment.
Fingers crossed!
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Anonymous
Re: Chemo ineffective... Now what?
Best wishes to your father, and to your family.
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dnalex - Name: Alex N.
- Who do you know with myeloma?: mother
- When were you/they diagnosed?: 2007
- Age at diagnosis: 56
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