[MichelP]

Experiences with CyBorD (VCD) induction therapy?

by MichelP on Fri May 27, 2011 1:20 pm

Hello all,

I’m a 56 years old man, newly diagnosed with multiple myeloma, I actually was diagnosed with indolent multiple myeloma six years ago, but the disease has progressed to a point where I now require treatment. I am supposed to start next week an induction therapy with a combination of oral cyclophosphamide, bortezomib (Velcade) and dexamethasone (I’m told it’s called CyBorD). I’m supposed to get this once a week for a period of about 4 months then followed by a stem cell transplant if the response is appropriate.

I was told of the potential side effects, but I am not quite sure what to expect. I was wondering if someone here had some experience with this treatment regimen and can share his experience. My main concern is about my ability to keep working (I have a job as a programmer-analyst, so it’s not physically too demanding but does require a certain amount of concentration) during the treatment.

Thanks in advance.

Moderator's Note: The CyBorD regimen is also sometimes abbreviated "VCD".

[Dr. David Siegel]

Re: Experiences with CyBorD (VCD) induction therapy?

by Dr. David Siegel on Fri May 27, 2011 9:58 pm

Cytoxan, Velcade and Dex has become a very popular combination for the treatment of multiple myeloma. It is probably more popular outside of the US for the initial treatment of multiple myeloma. (where the most popular triplet is probably VRD). We certainly use it a lot, with good success. It can be given on a number of different schedules, one of which you are describing. I would be very interested to hear how some of the other newly diagnosed pts who get CyBorD think about this regimen, as we mostly use it in the salvage setting. Our salvage pts seem to tolerate it very well, so I would expect that in newly diagnosed pts that would be even more true.

My guess would be that you should be able to keep working, although, as you bring up, dexamethasone can make it hard to concentrate.

[meeshymeesh]

Re: Experiences with CyBorD (VCD) induction therapy?

by meeshymeesh on Tue Jun 14, 2011 1:55 pm

Hi My Name is Michelle and I am 42 and was dx'd with Smoldering multiple myeloma in June 2009. In Feb 2011 it became active and like you Michel required treatment due ti low HGB and suspicious areas on the PET scan. I started with RVD on March 8th 2011 with an M spike of 2.7. After 4 rounds it has plateaud at 1.5, was 1.6, from 1.7, from 2.1.

My ONC/HEM has also decided to try CVD. I will start next week on the following 21 day schedule - Tues, Fri, Tues, Fri then 1 week off (1 cycle).

Would love to hear how you are tolerating the CVD and how it affects your numbers, Michel.

[MichelP]

Re: Experiences with CyBorD (VCD) induction therapy?

by MichelP on Tue Jun 14, 2011 5:11 pm

Hello Michelle,

I've only had two treatments thus far and haven't seen any numbers yet, so I'm afraid I can't tell you much as for the results. Also my protocol is somewhat different then the one you will get as I'm scheduled for one treatment per week with no break for about 4 months. I'm also scheduled to receive Aredia infusion once a month.

What I can tell you is that so far I have very little side effects. Mild nausia and some fatigue on the first couple of days after the treatment, that's it. No sign of neuropathy yet. If it stays like that i'll consider myself lucky.

I'll let you know about my numbers later on if you wish once I have the first results.

I wish you the best possible outcome, hang in there!

Michel,

[orchid]

Re: Experiences with CyBorD (VCD) induction therapy?

by orchid on Mon Jan 13, 2014 9:45 am

Hi Michel

My brother is about to start this regimen today in Montreal.

I hope that your treatment went you have hoped. I am wondering if you can share your experience with the CyBorD therapy and its associated side affects.

thanks in advance!

orchid

[Mattias]

Re: Experiences with CyBorD (VCD) induction therapy?

by Mattias on Mon Jan 13, 2014 12:48 pm

Hello!

My history is solitary plasmacytoma in left femur 2009. I suffered a pathological fracture. Treatment was surgery and radiation. At the time I was non secretory. In 2010 a small m-spike started to show in nov. Bad back pain in may 2011 with a continuing rise in m-spike. New solitary plasmacytoma in vertebra L1. Bone marrow biopsy showed no signs of myeloma nor did MRI or CT. Hence local treatment with surgery and radiation. After treatment the m-spike disappeared!
I was in complete remission until sep 2012 when the m-spike started to show again. This time without any scelettal/bone pain. Nov 20 2013 diagnosed with multiple extramedullary plasmacytomas. There were four of them. M-spike 27g/l serum. Bone marrow biopsy showed no myeloma! Plasma cells below 5%. Morphology of the cells healthy. FISH and flow cytometry alright.
Strange......
Anyway, specialists from southern Sweden were consulted and treatment were decided to be induction therapy on VCD and later on high dose chemo with auto SCT. I'm on day 7 in the third induction cycle. After two cycles I'm in "complete remission". No m-spike can be measured! Minimal side-effects mainly from the Dex. I'm supposed to to four induction cycles of 21 days before the SCT. I do hope for the best and feel great at the moment.

Best regards from Mattias in Sweden

[orchid]

Re: Experiences with CyBorD (VCD) induction therapy?

by orchid on Mon Jan 13, 2014 5:46 pm

Thanks Mattias for sharing your history with the disease and CyborD experience, I hope all goes well for you! By the way, is your CyborD treatment once a week?

I would like to get some advice from the forum on what numbers (blood test or others) we should watch for as the treatment goes on. We have this on our list:

- M protein (peak) for sure as it is about ~33
- Lamda is extremely high ~760 so we should watch for it
- Hemoglobin was very low (if not for the blood transfusion), now it is at 86
- Plasma cell in the bone marrow is quite high ~85 %

But I am wondering if you may suggest other things?

Thanks in advance.

[kjpoppit]

Re: Experiences with CyBorD (VCD) induction therapy?

by kjpoppit on Tue Jan 14, 2014 2:38 am

Hi, I have had 8 treatments of CyBorD so far as a first line treatment. I get it once a week. I was diagnosed in September of 2013 and started treatment in early December.

The Velcade is by subcutaneous injection into my stomach. It causes red rashes at the injection site that can be a little itchy but it is tolerable. I use a hydrocortisone cream to help the itch. I have no real issues with neuropathy. My stomach may get a little sensitive and I am fatigued but able to function with a full work schedule. I take omeprazole daily to help with stomach issues and it works just fine.

The dexamethasone does cause issues with sleep for me but I take an Ambien [zolpidem] if needed and just deal with it best I can. I would have to say this has been rather easy for me and I hope it continues to be that way.

My M-spike was 4.3 when I started and after 4 treatments it was 0.7. I believe this is awesome but the doctor has yet to discuss these lab results with me.

Best of luck to you.

[Mattias]

Re: Experiences with CyBorD (VCD) induction therapy?

by Mattias on Tue Jan 14, 2014 3:48 am

Hello!

I receive cyclophospamide on day 1, Velcade day 1, 4, 8, 12 and dex on day 1, 2, 4, 5, 8, 9, 11, 12. Then rest until 21 days have past from day 1. // Mattias

[Joebcourtney]

Re: Experiences with CyBorD (VCD) induction therapy?

by Joebcourtney on Tue Jan 14, 2014 1:21 pm

I was diagnosed in May 2007. Used Velcade/dex as induction, then SCT which allowed me to go 30 months w/o any treatment (except Zometa). Then tried Rev at low doses but could not tolerate (felt too nauseous, tired and sick) then a clinical trial w/Pom , but that affected me about the same as Rev. During the 14 months when I struggled with the IMIDS, my M-spike vacillated between 1.4 and 2.7. 29 months ago went on Velcade for three months and it held M-Spike at around 2, then we added 650 mg of CY to the Velcade and dex.

That slowly brought M-Spike down to 1.5 over the course of a year. During that time the Cy made me very sick for three days, so I reduced taking it only on week one and two , (with sub Q Vel/dex on week 3) The effects seemed to get worse, so it got reduced to Cy only on week 1. That was a lot easier to take, but last August M-Spike crept up and after 3 cycles it was 1.9. We then "blasted" it by doubling the CY and giving it on week 1 and 2 and also going to Velcade by infusion. After 3 cycles M-Spike was town to 1.6, but I couldn't bear taking that much Cy (1050mg on weeks 1 and 2.) Plus the infusion vel was causing whole body to ache. So now, after 24 months on various CY/Vel/dex doses I am taking 650mg of CY on weeks 1 and 2 -along with Vel/dex, and vel/dex only on week 3.

I have feeling that this treatment is running out of time, but hope to squeeze in as many more months as I can. I am incredibly grateful to have gotten 30 months out of it. I am "lucky" in that my disease in current form is Ok to have M-Spike as high as at least 2.0. I am unlucky in that I do not seem to tolerate the IMIDS. Am hoping I will possibly tolerate Pom -possibly 2 weeks on two weeks off - along with Carfilsomib or Velcade or something like that. Sometimes anxious about what will be next. One Day at a Time!
Joe