I'm writing for an advice for my father-in-law. It would be great if you can give a suggestion on what possible course of actions can be taken for his management / treatment or please share any similar experience. I'm sending case summary from his doctor below.
Mr X, 63 years, was diagnosed to have multiple myeloma stage3b in October 2014, when he presented with hypercalcemia and renal failure. He is a known CAD (coronary artery disease) patient with ischaemic cardiomyopthy and EF (ejection fraction) of 35%.
Patient initially received XRT (x-ray therapy) to cervical vertebrae and was then started on lenalidomide (Revlimid) + weekly dexamethasone (LD). He was reevaluated in May 2015, when light chain assay showed progressive increase, Hence he was planned for addition of weekly cyclophosphamide to LD regimen (CLD).
Patient was however not tolerating the CLD regimen and was repeatedly developing myelosuppresion. BMA (bone marrow aspiration) done in July 2015 revealed hypercellular marrow with myeloid hypoplasia and 58% plasma cells. The prognosis and options were discussed with the patient and he was initiated on weekly bortezomib (Velcade) + dexamethasone regimen.
He received the first dose of the same on July 31, 2015. Further chemotherapy could not be given as patient developed severe myelosuppression, with Hb dropping to 5.6g% and platelets dropping to 35000. Patient was supported with blood component support.
He has been advised to review after 1 week with CBC to plan further management. Please do the needful for him.
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Re: Father-in-law stage 3b multiple myeloma
Hi Petergeorge,
Sorry to hear about your father-in-law's situation. It sounds like he is going through a lot right now.
The most important thing that Mr. X can do is to seek out a top multiple myeloma specialist (not just an oncologist that has some familiarity with multiple myeloma) to get his/her advice under the circumstances. If you can let us know which city he lives in, folks can make some recommendations on where to find these specialists.
Myelosuppression does occur with some patients with novel agents like Revlimid and Velcade. There are some useful insights into managing myelosuppression in this article:
https://cjon.ons.org/cjon/12/3/supplement/myelosuppression-associated-novel-therapies-patients-multiple-myeloma-consensus/html/full
Obviously, your docs need to be mindful of his heart condition (which I'm sure they are) and that will somewhat limit the choices of some of the multiple myeloma therapies that are available.
What, if any, adverse chromosomal abnormalities (cytogenetics) showed up on his bone marrow biopsy tests?
Sorry to hear about your father-in-law's situation. It sounds like he is going through a lot right now.
The most important thing that Mr. X can do is to seek out a top multiple myeloma specialist (not just an oncologist that has some familiarity with multiple myeloma) to get his/her advice under the circumstances. If you can let us know which city he lives in, folks can make some recommendations on where to find these specialists.
Myelosuppression does occur with some patients with novel agents like Revlimid and Velcade. There are some useful insights into managing myelosuppression in this article:
https://cjon.ons.org/cjon/12/3/supplement/myelosuppression-associated-novel-therapies-patients-multiple-myeloma-consensus/html/full
Obviously, your docs need to be mindful of his heart condition (which I'm sure they are) and that will somewhat limit the choices of some of the multiple myeloma therapies that are available.
What, if any, adverse chromosomal abnormalities (cytogenetics) showed up on his bone marrow biopsy tests?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
2 posts
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