[mmjakarta]

CyBorD vs RVD and dosage?

by mmjakarta on Wed Dec 23, 2015 7:48 am

Hi all,

My mother has kappa light chain only myeloma, which is quite high.
Kappa FLC 2188 and Free Kap/Lam ratio 72
Plasma cells from bone marrow aspirate test shows 11%
B2 microglobulin 4,698
and quite a number of bone lytic lesions in the spine only (she had massive spine stabilization already)

Fortunately her cytogenetics and FISH test are normal, no abnormalities at all. Blood test hemoglobin, calcium and renal function test are also at normal range. No M band/spike detected

The doctor suggests us to start with CyBorD (cyclophosphamide, Velcade, dexamethasone) once a week for 4 - 6 months, but I am not sure about the dosage. Currently he suggests my mom takes 10 tablets @5mg of cyclophosphamide at once.

She currently looks very healthy, she can still travel overseas etc with just very occasional minutes of bone sore. Considering the side effect of those 3 chemo drugs, I am feeling it's unfair to make her sick from the side effects and not sure 500 mg tablet is right dose for cyclophosphamide?

Also wondering if Revlimid has fewer side effect than cyclophosphamide.

Thanks

[Multibilly]

Re: CyBorD vs RVD and dosage?

by Multibilly on Wed Dec 23, 2015 11:52 am

MMjakarta,

There are many possibilities for CyBorD dosing. While docs can certainly create their own custom dosing schemes, below are three of the more common, published dosing schemes:

Days 1, 4, 8, and 11: Bortezomib 1.3mg/m2 IV push over 3–5 seconds or SC

Days 1, 8, 15, and 22: Cyclophosphamide 300mg/m2/day orally

Days 1–4, 9–12, and 17–20: Dexamethasone 40mg orally daily.

Repeat cycle every 4 weeks for 3–4 cycles.

OR

Days 1, 4, 8, and 11: Bortezomib 1.3mg/m2 IV push over 3–5 seconds or SC

Days 1, 8, and 15: Cyclophosphamide 500mg/m2/day orally

Days 1, 8, and 15: Dexamethasone 40mg orally daily.

Repeat cycle every 3 weeks for 3–4 cycles.

OR

Days 1, 4, 8, and 11: Bortezomib 1.3mg/m2 IV push over 3–5 seconds or SC

Day 1: Cyclophosphamide 900mg/m2 IV over 60 minutes

Days 1 2, 4, 5, 8, 9, 11, and 12: Dexamethasone 40mg orally daily.

Repeat cycle every 3 weeks for 3–4 cycles.

Note that the Mayo recently substituted RVd for CyBorD in their standard mSMART guidelines for standard and intermediate-risk NDMM patients. So considering RVd as a substitute for CyBorD seems like a reasonable thing to discuss with the doctor.

http://www.msmart.org/about.html