The Myeloma Beacon

Independent, up-to-date news and information for the multiple myeloma community.
Home page Deutsche Artikel Artículos Españoles

Forums

Discussion about multiple myeloma treatments, stem cell transplants, clinical trials, alternative medicines, supplements, and their benefits and side effects.

CyBorD consolidation, then relapse - what now, what next?

by InQ on Fri Nov 07, 2014 2:15 pm

First off, I want to say thank you to the Myeloma Beacon and to the folks in this forum. You have helped us through some tough times.

Around last December, the symptoms for multiple myeloma became readily apparent affecting bodily function. We had smoldering myeloma, and were doing the wait and see approach. Then in December, it all changed. Pain around the body, difficult walking, difficulty going to the bathroom, and renal failure.

We had a bone marrow biopsy (BMB) with ~90% monoclonal cells.

Over the course of 9 months we were on CyBorD / VCD (cyclophosphamide, Velcade, dexamethasone) and eventually Zometa and the monoclonal cells went down to 5-10%. Yay! Momentarily.

We've been off of CyBorD for 2 months. The protein count was elevated, so they did another BMB, and unfortunately the monoclonal cells went up. I don't know by how much, but it was high enough that the doctor decided to start treatment again. This time with carfilzomib (Krypolis).

  1. I am surprised that the doctor decided to go with carfilzomib instead of back to CyBorD. Is there are benefit or drawback to this approach? I always thought you move on to the next drug if the current drug stopped working. From my understanding carfilzomib acts in a similar way to Velcade.
     
  2. For anyone that has taken carfilzomib - What are the side-effects that occurred? How well did you tolerate it? How long did you take it? Did you have a relapse after taking it? If so, how long did it take to relapse?
     
  3. What's next after carfilzomib? My understanding is that most doctors do something like CyBorD, then move to carfilzomib, but what after carfilzomib?
     
  4. Were we technically in remission for a brief moment? I am not sure of the definition of remission.

InQ

Re: CyBorD consolidation, then relapse - what now, what next

by antelope1225 on Fri Nov 07, 2014 11:42 pm

Hi InQ.

I do not have first hand knowledge of that, but I put Kyprolis (Carfilzomib) in the search at the top of the page and there were several news article about it.

antelope1225
Name: Cathy1225
Who do you know with myeloma?: Myself
When were you/they diagnosed?: May 25 2012
Age at diagnosis: 55

Re: CyBorD consolidation, then relapse - what now, what next

by Tough Mom on Sun Nov 16, 2014 10:54 pm

Hi InQ,

To address your last question first, we can't really know what level of remission you went into without knowing a lot more about your lab results, but certainly you saw your myeloma responding if your plasma cell levels went from 90% monoclonal cells down to 5-10%. Really sorry that you were not able to stay off treatment for longer.

With regards to carfilzomib (Kyprolis) side effects, strongly suggest you read the package insert for this drug and ask your physician about any that don't make sense. Fatigue and low blood counts are very frequent. Shortness of breath is common. Peripheral neuropathy is less frequent than with Velcade but it still occurs. There are serious heart effects as well that are not very frequent but it is important to know side effects that might happen so you can watch out for them, and know when to seek medical attention. The manufacturer of this drug publishes a patient brochure that is really pretty good - available at this web site:

http://www.kyprolis.com/starting-kyprolis/resources

Regarding other options, I wonder why your physician did not want to try an immuno­modu­latory agent like lenalidomide (Revlimid)? Carfilzomib is in the same category as bortezomib and since you relapsed within 2 months of stopping bortezomib, your myeloma is now considered to be "refractory" to bortezomib. Often it is a good idea to switch to a different kind of drug to get a better response. Carfilzomib is known to work better in patients whose disease is not bortezomib-refractory than in those whose myeloma is. Maybe there is a good reason for you why immunomodulatory agents are not right, but this might be something to talk to your doctor about.

Tough Mom
Who do you know with myeloma?: myself
When were you/they diagnosed?: January 2013
Age at diagnosis: 45

Re: CyBorD consolidation, then relapse - what now, what next

by InQ on Tue Nov 18, 2014 12:06 am

What does "refractory" mean? I thought it meant the drug no longer works. Rather in our case, we went off the drug, and the disease came back.

InQ

Re: CyBorD consolidation, then relapse - what now, what next

by Multibilly on Tue Nov 18, 2014 9:53 am

InQ,

I think Tough Mom is right. Technically, "refractory" can mean that the drug(s) have ceased to work and have a low response rate or that your disease has progressed within 60 days of completion of a drug(s). At least, that is my understanding.

In any case, your doc would be in the best position to make a recommendation on the next step under these circumstances.

Multibilly
Name: Multibilly
Who do you know with myeloma?: Me
When were you/they diagnosed?: Smoldering, Nov, 2012

Re: CyBorD consolidation, then relapse - what now, what next

by InQ on Tue Nov 18, 2014 10:36 pm

OIC. Thanks for the clarification.

InQ


Return to Treatments & Side Effects