Hi everyone. My Mom (multiple myeloma diagnosed at age 70, 3 years ago, IgG kappa) is contemplating starting treatment with Melphalan (alkeran) and prednisone at 10 mg/80 mg dosage for four days then off for 24 days - for relapse of multiple myeloma. This is NOT pre-stem cell therapy.
She previously had partial remission for over a year with the M protein barely detectable and serum FLC, beta-2 microglobulin, and IgG all in the normal range, but she did not have a re-do of a bone marrow biopsy. This was with only 12 NONconsecutive days of Revlimid and dexamethasone (25 mg/40 mg). She was on Rev for 6 days, one pulse dose of dex and ended up in hospital with pneumonia. After 3 weeks, she started same regimen back up - 6 days later she had shortness of breath and several other side effects, went off of it again. Then her numbers dropped into normal, etc.
So then after that year, her numbers started climbing. She found an oncologist who was willing to work with her - palliatively - and who respected the fact that she is highly sensitive to all medications (good in that she responded quickly to Rev/dex, bad in that she has side effects seeming much quicker than many). He started her back on Rev/dex at a lower dose and with each side effect that she had, he worked with her on doing different combinations of the Rev/dex including lowering dex, doing every other day Rev, etc. Finally last month with bleeding spots randomly occurring everywhere, rashes, and recurrence of her back pain, she stopped it. We found out this past week her IgG has almost doubled (from 2936 to 4026), serum FLC up almost 2-1/2 from 196 to 506, and beta 2 went from 2.56 (normal for this lab is 2.55) up to 3.1. In past three years since diagnosis her max IgG was 8030 (normal range of 70-1600), serum FLC was 121 (normal range 3.3 to 19.4) and beta-2 was 4.3.
Anyway - so, i searched the forums for info on this combo of drugs and the last I see was a couple people were possibly starting it in March 2012 - I am hoping you will see my post and share how you are doing with it.
***I would like to find out if you had many side effects, if you are still on it, if it is effective and how long it took to see a drop in your markers, etc. From what I read the usual course is 6 weeks... with testing every month. And that they WANT the white count and platelet counts to go down for it to be effective/working on the myeloma cells? Or is that just for pre-SCT therapy? I also read melphalan can affect the kidneys. ***
My mother's calcium is in normal as well as her creatinine and BUN (normal kidney function since diagnosis and up to now), and she has no current anemia. SHe did have anemia at diagnosis and has had it recur with just barely out of normal CBCs a couple of times - but for the post part for the 3 years since diagnosis, no anemia or issues related to it.
I have read plenty about melphalan and prednisone - side effects to watch for, etc. - so I'm not looking for websites but In Real Life experience - previously or current. Thanks for your help!
Forums
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Twi - Name: Twi
- Who do you know with myeloma?: My wonderful Mom, Janet
- When were you/they diagnosed?: May 2010
- Age at diagnosis: 70
Re: Experience with Melphalan (alkeran) and prednisone?
Dear Twi,
Although we talk a lot about high-dose melphalan in the context of autologous stem cell transplant on this site, we do not spend much time discussing the gentler side of melphalan, i.e. the much lower dose oral melphalan (Alkeran) that is used in the non-transplant setting. In my experience, it is well tolerated, and I have had patients into their 90s taking this treatment. The main issue with melphalan would be low blood counts (low white cells, anemia, low platelets), which can be increasingly problematic with longer term therapy. This will need to be watched closely. Occaionally, people will get gastrointestinal side effects (nausea, loss of appetite, stomach upset, diarrhea), but they are usually mild and manageable. I think the prednisone will be harder than the melphalan. How she does on prednisone will largely depend on how she did on dexamethasone. The dose of prednisone your Mom will be receiving is roughly equivalent to a 16 mg dose of dex. The mood changes and insomnia with prednisone may not be as bad as they are with dex.
Let us know how things go and best of luck to your Mom!
Pete V.
Although we talk a lot about high-dose melphalan in the context of autologous stem cell transplant on this site, we do not spend much time discussing the gentler side of melphalan, i.e. the much lower dose oral melphalan (Alkeran) that is used in the non-transplant setting. In my experience, it is well tolerated, and I have had patients into their 90s taking this treatment. The main issue with melphalan would be low blood counts (low white cells, anemia, low platelets), which can be increasingly problematic with longer term therapy. This will need to be watched closely. Occaionally, people will get gastrointestinal side effects (nausea, loss of appetite, stomach upset, diarrhea), but they are usually mild and manageable. I think the prednisone will be harder than the melphalan. How she does on prednisone will largely depend on how she did on dexamethasone. The dose of prednisone your Mom will be receiving is roughly equivalent to a 16 mg dose of dex. The mood changes and insomnia with prednisone may not be as bad as they are with dex.
Let us know how things go and best of luck to your Mom!
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Experience with Melphalan (alkeran) and prednisone?
Thank you so much, Dr. Voorhees, for your reassuring reply. You echo my mother's oncologist about good tolerance for older people. What worries me is that my Mom has had a life long sensitivity and intolerance and flat-out allergic reactions to a very long list of meds. But, hopefully her sensitivity will also give her a quick response to the MP regimen.
My Mom has tolerated the dex so-so. She got used to the not sleeping part and made lemonade out of lemons and didn't mind the increased energy level. She also experienced back pain close to the time of her dex dosage but it would wear off after a day or two. We're not really sure what was causing the majority of her side effects, but probably the Revlimid - spontaneous bleeding spots all over, rashes, blotchy spots, skin splitting on her fingertips and bleeding, and fatigue and a general malaise.
I believe her last dex dose was 20 mg (just the once a week). So, the 80 mg is a rough equivalent to 16 mg of dex? Then at 80 mg x 4 days - or 16 mg equivalent to dex x 4 which equals 64 mg, she will be getting about triple the dex dose in the prednisone equivalent (20 mg once a week to 64 mg equivalent) - did I get that right? Isn't that a huge jump ?
What are the side effects one sees with the 80 mg per day/4 day regimen prednisone? Is there anything she can do to preempt any of them? Or is it mostly the insomnia and mood changes?
At first glance, I must admit imagining 4 days on meds and then 24 days off (compared to the Rev/dex regimen), the MP regimen seems like surely it would be easier to take? How long do the side effects of the nausea/loss of appetite/stomach upset/diarrhea from the melphalan usually last after the 4 days are finished? Are they short lived? My Mom doesn't have a huge buffer of weight to lose. How are these side effects managed?
I appreciate your response Dr. Voorhees.
My Mom has tolerated the dex so-so. She got used to the not sleeping part and made lemonade out of lemons and didn't mind the increased energy level. She also experienced back pain close to the time of her dex dosage but it would wear off after a day or two. We're not really sure what was causing the majority of her side effects, but probably the Revlimid - spontaneous bleeding spots all over, rashes, blotchy spots, skin splitting on her fingertips and bleeding, and fatigue and a general malaise.
I believe her last dex dose was 20 mg (just the once a week). So, the 80 mg is a rough equivalent to 16 mg of dex? Then at 80 mg x 4 days - or 16 mg equivalent to dex x 4 which equals 64 mg, she will be getting about triple the dex dose in the prednisone equivalent (20 mg once a week to 64 mg equivalent) - did I get that right? Isn't that a huge jump ?
What are the side effects one sees with the 80 mg per day/4 day regimen prednisone? Is there anything she can do to preempt any of them? Or is it mostly the insomnia and mood changes?
At first glance, I must admit imagining 4 days on meds and then 24 days off (compared to the Rev/dex regimen), the MP regimen seems like surely it would be easier to take? How long do the side effects of the nausea/loss of appetite/stomach upset/diarrhea from the melphalan usually last after the 4 days are finished? Are they short lived? My Mom doesn't have a huge buffer of weight to lose. How are these side effects managed?
I appreciate your response Dr. Voorhees.
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Twi - Name: Twi
- Who do you know with myeloma?: My wonderful Mom, Janet
- When were you/they diagnosed?: May 2010
- Age at diagnosis: 70
Re: Experience with Melphalan (alkeran) and prednisone?
Actually, she was only on 8 mg (two 4-mg pills) of dex weekly. Because she had such strong side effects to Rev/dex... So this will be a huge jump for her, but for 4 days.
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Twi - Name: Twi
- Who do you know with myeloma?: My wonderful Mom, Janet
- When were you/they diagnosed?: May 2010
- Age at diagnosis: 70
Re: Experience with Melphalan (alkeran) and prednisone?
I wanted to check in again in the hopes of having some specific questions addressed about Melphalan/prendisone therapy (10 mg/80 mg), 4 days on, 24 off, in a NON-stem cell transplant setting.
Specifically:
1. With this drug regimen in older patients, what kind of side effects does one see?
A. Are the most common side effects from the prednisone (insomnia/mood changes)?
B. What kind of side effects come most from the Melphalan? Dr. Voorhees mentioned nausea/loss of appetite/stomach upset/diarrhea from melphalan - how long lived do these side effects tend to be, in general?
C. How are these side effects managed in an older patient who can scarcely afford to be nausea/vomiting/diarrhea with no weight buffer to lose, and every bite taken in counting in overall health and strength?
2. Can you give perspective - is going from 8 mg of weekly dex to four days of 80 mg per day (320 mg total) - a huge jump likely to have much more side effects? My mother's oncologist had kept decreasing her dex dose due to intolerance/side effects.
3. The 4 on/24 off regimen sounds appealing . In general, if one does have side effects (my mother is prone to having every side effect in the book on even low doses of chemo) - how long do they generally last? The entire 24 days after the 4 days of taking the regimen? a few days? weeks? Which side effects might last longer, which might resolve more quickly? In general of course, as I realize everyone reacts different. Just trying to get a feel for this and hear some actual experience about this MP regimen.
Thank you once again for all the help.
Specifically:
1. With this drug regimen in older patients, what kind of side effects does one see?
A. Are the most common side effects from the prednisone (insomnia/mood changes)?
B. What kind of side effects come most from the Melphalan? Dr. Voorhees mentioned nausea/loss of appetite/stomach upset/diarrhea from melphalan - how long lived do these side effects tend to be, in general?
C. How are these side effects managed in an older patient who can scarcely afford to be nausea/vomiting/diarrhea with no weight buffer to lose, and every bite taken in counting in overall health and strength?
2. Can you give perspective - is going from 8 mg of weekly dex to four days of 80 mg per day (320 mg total) - a huge jump likely to have much more side effects? My mother's oncologist had kept decreasing her dex dose due to intolerance/side effects.
3. The 4 on/24 off regimen sounds appealing . In general, if one does have side effects (my mother is prone to having every side effect in the book on even low doses of chemo) - how long do they generally last? The entire 24 days after the 4 days of taking the regimen? a few days? weeks? Which side effects might last longer, which might resolve more quickly? In general of course, as I realize everyone reacts different. Just trying to get a feel for this and hear some actual experience about this MP regimen.
Thank you once again for all the help.
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Twi - Name: Twi
- Who do you know with myeloma?: My wonderful Mom, Janet
- When were you/they diagnosed?: May 2010
- Age at diagnosis: 70
Re: Experience with Melphalan (alkeran) and prednisone?
Wanted to give an update on my Mom's experience so far with Melphalan and prednisone. She is 73 yrs old (diagnosed at age 70 with stage 2/3 kappa multiple myeloma). Her history of treatment back from May 2010 was an October 2010 remission that lasted over a year (remission being that her IgG, serum FLC, and beta-2 microglobulin were all in normal ranges with a very very low M spike but still detectable) - with a minimal amount of Rev/dex , only a total of 12 nonconsecutive days of the Rev/dex (full dose) - stopped due to serious side effects/intolerance. During the 1.5 year remission, she was not on maintenance and was on a very extensive supplement protocol. So her multiple myeloma markers increased over time until about 1.5 when they went out of range - and she went on varying lower doses of Rev/dex.
Completely out of remission in July 2012, delayed treatment a couple of months, ended up in hospital Oct 2012 with kidney failure (no dialysis required) from high calcium and very high serum FLC.
She went immediately on Velcade and dex (subcu V and short IV push dex) - for 7 cycles (once a week for 7 weeks) - with no response at all, in fact cancer numbers got worse - requiring her to have IV fluids weekly (to help the kidneys with the high calcium/light chain proteins) as well as blood transfusions due to very low hemoglobin from active multiple myeloma.
She went on Melphalan and prednisone - 6 mg Melphalan and 60 mg prednisone daily for 4 days, off for 3. weeks. She has completed one cycle of this. She responded by the 2nd week with not having to have any IV fluids/blood transfusions - as the calcium quickly dropped to normal and her hemoglobin has held steady (still anemic at 10.4 but way better than 6.4). And, she started feeling better bit by bit. Her multiple myeloma markers are still very high, but her serum FLC came down from crazy high 4300 to 750 with just this one cycle - theoretically, if the same response occurs, her second M&P cycle should drop the serum FLC into normal range (3.3 to 19.4).
She continues to improve in her activities of daily living (not needing the rolling walker which she has needed since Oct after the hospitalization for the kidney failure), appetite starting to return (nonexistent for 4 months), easier to chew food (needed tons of water to choke food down, a tad more energy, more alertness and staying awake all day, (she often slept the days away) - overall a general improvement in about every area now that the multiple myeloma has started to be kicked back down by the M&P.
She is on her 2nd cycle right now. Her oncologist onco upped the Melphalan to 8 mg since her kidneys are doing okay but kept prednisone same 60 mg. Cycle remains the same - 4 days on the pills then 3 weeks off.
Her tolerance has thus far been pretty good. She takes it in the morning. On the first evening of starting both cycles, she had severe itching. The first time it was in her abdomen; this time in her legs/feet. There is no redness, warmth, rash, or any discoloration at all. It seems to be more of an inner type itch? Taking one OTC Benadryl seems to relieve it and then it seems to dissipate completely. Of course the prednisone brings the jittery energy increase and helps her to eat better (she has lost lots of weight in during these last 4 months of trying to get the multiple myeloma under control).
Her white cells tanked at around day 7 to 10 - which from what I found online is expected. Then the white cells start to go back up towards normal. She also spiked a fever on the same day the white cells tanked (down to 1.2, with low range of normal being I think 4)... that night I set the alarm for every few hours and watched her temp - it went down through the night, so we avoided an emergency room visit/hospitalization, thank goodness.
We will see how the second round goes, if any different side effects, if her white cells tank again, etc. But so far, the side effects have been tolerable at least with 1 round and the start of the second round.
I wanted to post this information for anyone in the future who might be on M&P for treatment (rather than having Melphalan prior to stem cell transplant) as when I asked about it, it seemed there were not many who have had this treatment except for SCT prep. I hope this might help another person looking at taking M&P for treatment.
Completely out of remission in July 2012, delayed treatment a couple of months, ended up in hospital Oct 2012 with kidney failure (no dialysis required) from high calcium and very high serum FLC.
She went immediately on Velcade and dex (subcu V and short IV push dex) - for 7 cycles (once a week for 7 weeks) - with no response at all, in fact cancer numbers got worse - requiring her to have IV fluids weekly (to help the kidneys with the high calcium/light chain proteins) as well as blood transfusions due to very low hemoglobin from active multiple myeloma.
She went on Melphalan and prednisone - 6 mg Melphalan and 60 mg prednisone daily for 4 days, off for 3. weeks. She has completed one cycle of this. She responded by the 2nd week with not having to have any IV fluids/blood transfusions - as the calcium quickly dropped to normal and her hemoglobin has held steady (still anemic at 10.4 but way better than 6.4). And, she started feeling better bit by bit. Her multiple myeloma markers are still very high, but her serum FLC came down from crazy high 4300 to 750 with just this one cycle - theoretically, if the same response occurs, her second M&P cycle should drop the serum FLC into normal range (3.3 to 19.4).
She continues to improve in her activities of daily living (not needing the rolling walker which she has needed since Oct after the hospitalization for the kidney failure), appetite starting to return (nonexistent for 4 months), easier to chew food (needed tons of water to choke food down, a tad more energy, more alertness and staying awake all day, (she often slept the days away) - overall a general improvement in about every area now that the multiple myeloma has started to be kicked back down by the M&P.
She is on her 2nd cycle right now. Her oncologist onco upped the Melphalan to 8 mg since her kidneys are doing okay but kept prednisone same 60 mg. Cycle remains the same - 4 days on the pills then 3 weeks off.
Her tolerance has thus far been pretty good. She takes it in the morning. On the first evening of starting both cycles, she had severe itching. The first time it was in her abdomen; this time in her legs/feet. There is no redness, warmth, rash, or any discoloration at all. It seems to be more of an inner type itch? Taking one OTC Benadryl seems to relieve it and then it seems to dissipate completely. Of course the prednisone brings the jittery energy increase and helps her to eat better (she has lost lots of weight in during these last 4 months of trying to get the multiple myeloma under control).
Her white cells tanked at around day 7 to 10 - which from what I found online is expected. Then the white cells start to go back up towards normal. She also spiked a fever on the same day the white cells tanked (down to 1.2, with low range of normal being I think 4)... that night I set the alarm for every few hours and watched her temp - it went down through the night, so we avoided an emergency room visit/hospitalization, thank goodness.
We will see how the second round goes, if any different side effects, if her white cells tank again, etc. But so far, the side effects have been tolerable at least with 1 round and the start of the second round.
I wanted to post this information for anyone in the future who might be on M&P for treatment (rather than having Melphalan prior to stem cell transplant) as when I asked about it, it seemed there were not many who have had this treatment except for SCT prep. I hope this might help another person looking at taking M&P for treatment.
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Twi - Name: Twi
- Who do you know with myeloma?: My wonderful Mom, Janet
- When were you/they diagnosed?: May 2010
- Age at diagnosis: 70
Re: Experience with Melphalan (alkeran) and prednisone?
Dear Twi,
Thank you for sharing your mother's experiences. I can tell that you are a loving daughter and a wonderful caregiver!
My 72 year old mother was diagnosed in Oct. 2011 and has become refractory to both Revlimid and Velcade. She's currently on carflizomib (Kyprolis) and dexamethasone and has just completed two cycles with good response. We're hoping that she can continue on this for a long time, but her doctor has mentioned that melphalan/dex would probably be his next choice at relapse.
I hope and pray that your mother continues to tolerate and respond well to this therapy. Thanks again for sharing and I hope you will continue to update.
Blessings,
Lisa
Thank you for sharing your mother's experiences. I can tell that you are a loving daughter and a wonderful caregiver!
My 72 year old mother was diagnosed in Oct. 2011 and has become refractory to both Revlimid and Velcade. She's currently on carflizomib (Kyprolis) and dexamethasone and has just completed two cycles with good response. We're hoping that she can continue on this for a long time, but her doctor has mentioned that melphalan/dex would probably be his next choice at relapse.
I hope and pray that your mother continues to tolerate and respond well to this therapy. Thanks again for sharing and I hope you will continue to update.
Blessings,
Lisa
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Lisa B. - Name: Lisa B.
- Who do you know with myeloma?: My mother, Barbara Henson
- When were you/they diagnosed?: 10-28-11
- Age at diagnosis: 71
Re: Experience with Melphalan (alkeran) and prednisone?
Hello, Lisa. Thank you for your reply. I appreciate hearing what kind of treatment & experience your mother is having also. I'm happy for you and for your mother that she is having a good response with the two cycles of the carfilzomib and dex - is she having low to no side effects, hopefully? How are the Kyprolis and dex administered, by pill/IV/injection?
My Mom finished round 2 of the M&P last Friday - so far, so good. She did find that taking one Benadryl each night helped her sleep vs the dex keeping her up most of the night. She's had some high pulse rates lately with and without exertion - with a normal O2 sat and BP and no other symptoms (no sweating, SOB, swelling of feet or extremities, pain, etc.) but just nervousness and a little hand shaking. It was most concerning to me when it occurred at rest. We're hoping it's related to the dex and will taper off - it occurs randomly. The home care nurse is checking her right now - and we see the oncologist tomorrow.
My Mom is stable enough that we are making the long trek from Ohio (her home, my hometown) to Virginia where my husband and I live. It's hard for her to leave her home, but we will take her cats with us also and already some of her friends have talked of coming to visit her. I've been away from my home almost 4 months now, so she will spend a few months in Va with us, getting stronger, with our goal being to bring her and her cats back to her home with her being independent again! I've lucked out in getting her with a University of Virginia oncologist and in with a family practice doctor - first criteria I asked of the office manager was which of doctor is most likely to have a good sense of humor! My Mom loves to joke with her doctors. The home care agency (inhome rehab with PT/nurse/home aid for bathing) here already connected me with an agency there, so once the oncologist gives the order, she will be seen the next day.
Sending you the same hope and prayers for your mother's continued response and tolerance of her therapy. Will you please keep us updated also?
Blessings to you also...
Twi
My Mom finished round 2 of the M&P last Friday - so far, so good. She did find that taking one Benadryl each night helped her sleep vs the dex keeping her up most of the night. She's had some high pulse rates lately with and without exertion - with a normal O2 sat and BP and no other symptoms (no sweating, SOB, swelling of feet or extremities, pain, etc.) but just nervousness and a little hand shaking. It was most concerning to me when it occurred at rest. We're hoping it's related to the dex and will taper off - it occurs randomly. The home care nurse is checking her right now - and we see the oncologist tomorrow.
My Mom is stable enough that we are making the long trek from Ohio (her home, my hometown) to Virginia where my husband and I live. It's hard for her to leave her home, but we will take her cats with us also and already some of her friends have talked of coming to visit her. I've been away from my home almost 4 months now, so she will spend a few months in Va with us, getting stronger, with our goal being to bring her and her cats back to her home with her being independent again! I've lucked out in getting her with a University of Virginia oncologist and in with a family practice doctor - first criteria I asked of the office manager was which of doctor is most likely to have a good sense of humor! My Mom loves to joke with her doctors. The home care agency (inhome rehab with PT/nurse/home aid for bathing) here already connected me with an agency there, so once the oncologist gives the order, she will be seen the next day.
Sending you the same hope and prayers for your mother's continued response and tolerance of her therapy. Will you please keep us updated also?
Blessings to you also...
Twi
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Twi - Name: Twi
- Who do you know with myeloma?: My wonderful Mom, Janet
- When were you/they diagnosed?: May 2010
- Age at diagnosis: 70
Re: Experience with Melphalan (alkeran) and prednisone?
Hello Twi!
My mother received the Kyprolis/Dex combination by infusion. Fluids are given before and after the chemo (actually the Kyprolis is slowly injected into the IV line at the start of the second bag of fluids). She receives the infusion for two consecutive days each week for 3 straight weeks and then has 12 days "off". I wish I could tell you that she's had no side effects, but with her second cycle, she has experienced fever (100-101F) and mild diarrhea that last for about 24 hours following the infusions. She also experiences mild to moderate fatigue that gradually fades during her 12 days off.
Overall, the side effects don't interfere significantly with her daily activities, and her test results (both blood counts and lowering of M protein) are already better than they ever were on Revlimid/Dex or Velcade/Dex. She also feels and looks healthier than she has in a while!
I'm very happy that you were able to find a good local oncologist and general practitioner for your mother. I know you must be torn between needing to be home and wanting to be with her, and am glad it has worked out so well for her to stay with you for a while. (Bringing the cats is bound to help!
Your mom sounds a lot like mine as far as personality goes. My mom also loves to laugh and has a wonderfully positive outlook about everything. I believe that goes a LONG way in battling health issues!!
Please let your mom know that my mother, Barbara, and I are lifting her in prayer for successful treatment and no bad side efffects.
Thank you for posting!
Lisa
My mother received the Kyprolis/Dex combination by infusion. Fluids are given before and after the chemo (actually the Kyprolis is slowly injected into the IV line at the start of the second bag of fluids). She receives the infusion for two consecutive days each week for 3 straight weeks and then has 12 days "off". I wish I could tell you that she's had no side effects, but with her second cycle, she has experienced fever (100-101F) and mild diarrhea that last for about 24 hours following the infusions. She also experiences mild to moderate fatigue that gradually fades during her 12 days off.
Overall, the side effects don't interfere significantly with her daily activities, and her test results (both blood counts and lowering of M protein) are already better than they ever were on Revlimid/Dex or Velcade/Dex. She also feels and looks healthier than she has in a while!
I'm very happy that you were able to find a good local oncologist and general practitioner for your mother. I know you must be torn between needing to be home and wanting to be with her, and am glad it has worked out so well for her to stay with you for a while. (Bringing the cats is bound to help!
Your mom sounds a lot like mine as far as personality goes. My mom also loves to laugh and has a wonderfully positive outlook about everything. I believe that goes a LONG way in battling health issues!!
Please let your mom know that my mother, Barbara, and I are lifting her in prayer for successful treatment and no bad side efffects.
Thank you for posting!
Lisa
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Lisa B. - Name: Lisa B.
- Who do you know with myeloma?: My mother, Barbara Henson
- When were you/they diagnosed?: 10-28-11
- Age at diagnosis: 71
Re: Experience with Melphalan (alkeran) and prednisone?
Hi Lisa B! Thanks for the information about the Kyprolis/dex. So has your Mom's doctor said whether the Kyprolis/dex is required ongoing, or if it is something that is stopped once a remission is reached? We were encouraged when my Mom's oncologist told us once Mom's numbers are normal, she can stop the melphalan/prednisone and then be followed closely.
We did make it to my home in Virginia and Mom and her cats handled the 8+ hour drive quite well. Now we are going about settling in. We got to meet her new oncologist - we both loved her! Phew. Mom's hemoglobin has dropped again, so another transfusion may be necessary tomorrow. The new doc agreed with old doc that the current anemia is more related to the chemo and will over time resolve/improve, but she wants to be on safe side. My Mom's numbers have improved HUGELY on just 2 cycles of the M/P. There's a possibility the IgG, serum FLC, and beta 2 might drop into normal after the 3rd cycle. I think though maybe a fourth will be necessary. One can hope though.
So far, she continues to tolerate this regimen quite well with minimal side effects that include with first day of pills itching and of course sleeplessness with the dex; some noticeable increase in her back pain that resolves but is always on a couple days during the treatment; some fatigue. Of course clinically, she has the anemia and the white blood cell count drops quite a bit but then so far heads back towards normal.
Besides the great news that she is having a good response, her kidney function has essentially returned to normal, creatinine now at 1.3 (high end of normal range being 1.2). Further indication that the multiple myeloma is really responding to the M/P.
That's neat that our Mom's are similar in personality with laughter and positive outlook - I agree it goes a long way in this battle they face. Where do you all live?! I packed my Mom's funny/crazy glasses so she will have them handy here also - for years now, she keeps them handy in her purse. Evidently, you just never know when some laughter is in order.
I will tell my Mom (Janet) of your and your mother's prayers. Wishing continued good response for your Mom/Barbara.
We did make it to my home in Virginia and Mom and her cats handled the 8+ hour drive quite well. Now we are going about settling in. We got to meet her new oncologist - we both loved her! Phew. Mom's hemoglobin has dropped again, so another transfusion may be necessary tomorrow. The new doc agreed with old doc that the current anemia is more related to the chemo and will over time resolve/improve, but she wants to be on safe side. My Mom's numbers have improved HUGELY on just 2 cycles of the M/P. There's a possibility the IgG, serum FLC, and beta 2 might drop into normal after the 3rd cycle. I think though maybe a fourth will be necessary. One can hope though.
So far, she continues to tolerate this regimen quite well with minimal side effects that include with first day of pills itching and of course sleeplessness with the dex; some noticeable increase in her back pain that resolves but is always on a couple days during the treatment; some fatigue. Of course clinically, she has the anemia and the white blood cell count drops quite a bit but then so far heads back towards normal.
Besides the great news that she is having a good response, her kidney function has essentially returned to normal, creatinine now at 1.3 (high end of normal range being 1.2). Further indication that the multiple myeloma is really responding to the M/P.
That's neat that our Mom's are similar in personality with laughter and positive outlook - I agree it goes a long way in this battle they face. Where do you all live?! I packed my Mom's funny/crazy glasses so she will have them handy here also - for years now, she keeps them handy in her purse. Evidently, you just never know when some laughter is in order.
I will tell my Mom (Janet) of your and your mother's prayers. Wishing continued good response for your Mom/Barbara.
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Twi - Name: Twi
- Who do you know with myeloma?: My wonderful Mom, Janet
- When were you/they diagnosed?: May 2010
- Age at diagnosis: 70
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