[Lilly121]

Typical duration of induction treatment?

by Lilly121 on Thu Jun 04, 2015 9:25 am

Dear All,

I was wondering if anybody knows the minimum, maximum, and typical duration of induction therapy?

Also, how long is a 'cycle' of treatment?

Thank you,

Lilly

[JPC]

Re: Typical duration of induction treatment?

by JPC on Thu Jun 04, 2015 10:34 am

In the US, the recent "standard" of care has been 4 rounds of Revlimid, Velcade, and dexamethasone (RVD) or CyBorD (cyclophosphamide, Velcade, and dex). There are many reasons that one would deviate from the baseline. An autologous stem cell transplant (ASCT) would be possibly included after initial induction or after first relapse.

I could get into many of the possibilities, but I think you would be better served by going to the Mayo Clinic website, and looking up their "MSmart" guidelines for treatment of multiple myeloma at initial treatment, first relapse, and subsequent treatment. As far as guidelines go, it's very good, keeping in mind that all patients are different and there would be many individual reasons to deviate from the guidelines.

Here is a link:

http://www.msmart.org/

Good luck,

JPC

[JPC]

Re: Typical duration of induction treatment?

by JPC on Thu Jun 04, 2015 10:47 am

Regarding induction cycles, I have seen two schedules reported. A three week cycle and a four week cycle. The three week cycle would be two weeks of treatment with the final week off, and the four week cycle would be similarly 3 weeks on and 1 week off. There are completely different dosing schemes for the so called older / frail patients that I am not familiar with in detail.

[mrozdav]

Re: Typical duration of induction treatment?

by mrozdav on Thu Jun 04, 2015 3:00 pm

Hello, Lilly121.

I just finished reading a portion of a newsletter sent to me from the Mayo Clinic. It seems on point.

According to what I have read, the length of induction will depend on whether you are a can­di­date for a stem cell transplant or not. If you are a candidate and have standard risk myeloma, initial therapy will be for two to four months, followed by harvesting of stem cells. They rec­om­mend SCT immediately after recovering from the harvesting procedure. You may delay the transplant if you are standard risk for progression, but if you are intermediate or high risk, you probably do not have the option to delay. Mayo believes that if you have not had a lot of treatment for your myeloma, you generally have a better chance of responding positively to a SCT.

If you are NOT a candidate for SCT, induction therapy is given for up to one year and is not followed by SCT.

These recommendations are just that. Clearly, specialists have varying opinions as what is the best course to follow in individual cases.

[Norm]

Re: Typical duration of induction treatment?

by Norm on Sat Jun 06, 2015 7:32 pm

Based on what I had and what others have reported, a typical cycle is 4 weeks. If you are taking Revlimid and dex for induction therapy, then you would get 21 days of drugs followed by 7 days with no drugs. I have also read that four rounds of induction therapy prior to a SCT is typical, but it also depends on the results achieved. In my case, I had five rounds, as the doctors wanted my numbers to go down a little more.

[maryk]

Re: Typical duration of induction treatment?

by maryk on Sat Jun 06, 2015 11:10 pm

My husband was not eligible for a SCT so he had 9 cycles of Velcade, cyclophosphamide and dexamethasone on a 4 week on, 1 week off schedule, so it took a total of about 10 months. We live in British Columbia, Canada. And his response was marvelous!

[lys2012]

Re: Typical duration of induction treatment?

by lys2012 on Wed Jun 10, 2015 7:58 pm

My induction was 5 rounds of treatment (3-week cycles). Because I still had an M-spike, I guess they did an extra round.

Then I still had an M-spike and did a round of high-dose cyclophosphamide [Cytoxan], then collected my stem cells.

Then I did my transplant three weeks later when a bed opened up in the hospital (was inpatient).

It's now been 5 years since my transplant.

[Mister Dana]

Re: Typical duration of induction treatment?

by Mister Dana on Fri Jun 12, 2015 12:39 am

I had CyBorD weekly for five months (22 weeks) though I had a complete response going well before that time was up. I then took a few weeks off before heading out of town for my stem cell collection, high dose Melphalan, and autologous stem cell cell transplant.

[dranton]

Re: Typical duration of induction treatment?

by dranton on Fri Jun 12, 2015 4:14 pm

Lilly121, I think Norm is right about the usual framework for this. I had five three week-cycles prior to my Auto Stem Cell Transplant. We went five instead of four because of timing of the ASCT and because we were aiming to get my M-spike just a bit lower. It was starting to flatten out, but we thought one more cycle might help to get it as low as we could before transplant.