[heatherlib]

Re: DCEP for multiple myeloma: information?

by heatherlib on Fri Apr 17, 2015 1:58 pm

I was looking for posts about DCEP and it seems this is the only one on here.

I have had an intial therapy of 4 cycles of RVD (Revlimid, Velcade, dexamethasone), but my progress stalled / flattened out (M-spike went from 3.6 g/dL down to 2.1 g/dL, but then hovered in that area). I did one cycle of VCD (Velcade, cyclophosphamide, dexamethasone), and now my M-Spike is up to 2.4 g/dL.

If my blood work at Dana Farber (myeloma specialist) is similar to that I had done locally (Smilow), my myeloma specialist wants me to have one treatment of DCEP. Hopefully that will get me to a stem cell transplant in 8 weeks.

Any experience with this?

[Terrij]

Re: DCEP for multiple myeloma: information?

by Terrij on Fri Apr 17, 2015 5:49 pm

Since my original post, our daughter did have DCEP in November. She spent 4 days in the hos­pital and experienced the side effects of hair loss, nausea, and diarrhea at home. Un­fortu­nately she ended up back in the hospital for 2 weeks with C. diff and a very bad blood infection. She did not have another round of DCEP and she did not have an allo transplant (her brother is a half match) because her body was so weakened . Her myeloma numbers did not go down that much.

Jefferson Hospital in Philly recommended she go to Penn for a clinical trial. She started that trial in February and, after the first cycle, her kappa light chains went from 2700 to 25, with the other numbers falling drastically also. She will continue with this for a few more cycles and then deci­sions will be made for what is next. We have learned that, if you do an allo transplant, you cannot do T cell later if the allo doesn't work.

Every person is different in how their body will react . The DCEP treatment was actually not any harder than any other. It was the infections afterward that really took their toll on her.

Good luck in your treatment.

[antelope1225]

Re: DCEP for multiple myeloma: information?

by antelope1225 on Fri Apr 17, 2015 8:37 pm

I fought C. diff for 5 months after my SCT and I finally got cleared up (vancomycin every few hours). A real problem with having C. diff is that your daughter will need to be very careful of taking any antibiotics, because the antibiotics kill the good bacteria in her GI tract and allow the C. diff bacteria to flare up.

I found that in Canada they prescribe probiotics to fight C. diff. I take a probiotic every day, and when I must take an antibiotic, if I take one Saccharomyces boulardii within the hour of taking the antibiotic, I have no flare up of C. diff at all!.

I hope your daughter is doing better.

Cathy

[heatherlib]

Re: DCEP for multiple myeloma: information?

by heatherlib on Tue Apr 21, 2015 7:46 am

TerriJ,

I am so sorry your daughter had such a rough time post DCEP, but glad that you have found something that is working. If you don't mind, what is the clinical trial? Wishing you all the best moving forward.

I am going to Dana Farber this afternoon to be admitted for the DCEP treatment. Hoping for some good results and to avoid any post-treatment infections.

[Terrij]

Re: DCEP for multiple myeloma: information?

by Terrij on Tue Apr 21, 2015 10:30 am

Heather, our daughter is doing a trial of Pomalyst, dex, and oprozomib. Oprozomib is the pill version of carfilzomib (Kyprolis). It is working really well now, but we know the future holds some major decisions of things less toxic and longer lasting since she is so young (36 now).

Good luck with DCEP. Hope you avoid any complications.

[Cheryl G]

Re: DCEP for multiple myeloma: information?

by Cheryl G on Thu Apr 05, 2018 7:15 pm

Here's another study that came out recently about DCEP. It's by a group of researchers in Australia, who retrospectively look at the use of DCEP as bridging therapy.

My main takeaway from the paper is that, as has been mentioned before, DCEP can be helpful as a bridging therapy, but it definitely has its risks. Treatment-related mortality among the patients in this study was almost 10 percent, with deaths mainly occurring due to the low white cell counts that occur with the therapy.

Reference:

Yuen, HLA, et al, "DCEP as a bridge to ongoing therapies for advanced relapsed and/or refractory multiple myeloma," Leukemia & Lymphoma, April 4, 2018 (abstract)

Abstract:

"There is limited data describing dexamethasone, cyclophosphamide, etoposide, and cisplatin (DCEP) in relapsed refractory multiple myeloma (RRMM). We reviewed 65 patients with RRMM receiving DCEP between 2005 and 2017 in two Melbourne Hospitals. Patients had received a mean of three prior treatment lines (range, 1-11). The mean number of cycles of DCEP was two (range, 1-4). Overall response rate (ORR) was 55% whilst 19% achieved MR and SD. Median overall survival (OS) was 9.6 months. Those bridged to autologous stem cell transplant (ASCT) had significantly improved OS compared to those who were not (median 32.8 vs. 10.7 months, p=.0004). Significant treatment-related mortality (TRM) was observed (9.7%), mostly attributable to grade 3-4 neutropenia and febrile neutropenia. Mandatory use of G-CSF is, therefore, warranted to prevent septic complications. In heavily pretreated RRMM, DCEP is an effective bridge to definitive therapy but in the absence of the latter, its value is questionable."