Hi,
First of all, a big thanks for this forum and everyone who contributes to it. You won't even know how much it has helped me in these sudden uncertain times.
I'm Anirudh from India and my father, 58 years old, has been diagnosed with multiple myeloma 20 days ago. He had 43% plasma cells in his marrow so the doctors believed he had passed the wait-and-watch stage, and have put him on a couple of meds, bortezomib (Velcade) 2 mg, dexamethasone 40 mg, and Endoxan (Cytoxan, cyclophosphamide) 550 mg, to be taken every week.
Additionally, they told him to take Zometa 4 mg injection, which he took yesterday evening. And that's where my worry begins.
He took the injection around 5 pm yesterday and was fine till 6:30 pm. Around that time, he started feeling cold and got some uncontrollable chills for like 5 minutes. It's already 17 degrees C / 62 F here and he ate some cold fruits once he returned so I thought it might have been because of all that. Still I read the side effects of Zometa and it said some chills or flu-like symptoms can occur in some patients.
In an hour his temperature got normal and he started to sweat a little and got better. Even his fatigue went away.
But in the morning, around 5 am, he has developed a fever of 102 F, it's getting low by now; it's 9:30 am here; but I did some more reading and found that fever is a serious side effect of this medication and the specialist should be contacted, so I got a bit confused.
We don't have any specialist in my city and it's a public holiday today, so I want to know are these symptoms serious? Can anyone tell here from some experience?
I will take him to the emergency room in a couple of hours if the fever doesn't subside, but I would like to hear from someone if it's really serious.
Thank you.
Anirudh
Forums
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bhardwajanirudh - Name: Anirudh
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: March 14, 2016
- Age at diagnosis: 58
Re: Fever after Zometa infusion - is it serious?
I hope that your father is doing ok by now. Did you take him to the ER? Often people report having flu-like symptoms from the first Zometa infusion and may feel achy for a couple of days. In the States the normal infusion time is 15 minutes. But many people find that they need an infusion time of 30 min, or longer, to not have the flu-like symptioms.
The guideline that I received for a fever is that if I spike one of 100.5 deg F that I should call the oncologist on call at my hospital while I'm driving to the ER. I've also been told not to take acetaminophen (Tylenol, paracetamol) to control the fever if I'm going to the ER.
The beginning of treatment for myeloma can be very scary and confusing because one doesn't know what is a normal reaction for the person or what should be a concern. When in doubt call the doctor's office or go to the ER. Let them make the decision. Soon you will know what is an immediate concern for your father and what can wait until the next day.
Hopefully your father is feeling better. All the best to him and to you as you begin this new stage of your father's life.
Nancy in Phila
The guideline that I received for a fever is that if I spike one of 100.5 deg F that I should call the oncologist on call at my hospital while I'm driving to the ER. I've also been told not to take acetaminophen (Tylenol, paracetamol) to control the fever if I'm going to the ER.
The beginning of treatment for myeloma can be very scary and confusing because one doesn't know what is a normal reaction for the person or what should be a concern. When in doubt call the doctor's office or go to the ER. Let them make the decision. Soon you will know what is an immediate concern for your father and what can wait until the next day.
Hopefully your father is feeling better. All the best to him and to you as you begin this new stage of your father's life.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Fever after Zometa infusion - is it serious?
Thanks Nancy for the reply and yeah I think it'll get better with time.
I did call up my oncologist and she suggested he take a paracetamol (Tylenol, acetaminophen) tablet and, if the fever still doesn't go, then go to the ER. But thankfully it did, so phew.
I did call up my oncologist and she suggested he take a paracetamol (Tylenol, acetaminophen) tablet and, if the fever still doesn't go, then go to the ER. But thankfully it did, so phew.
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bhardwajanirudh - Name: Anirudh
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: March 14, 2016
- Age at diagnosis: 58
Re: Fever after Zometa infusion - is it serious?
Hello,
I am 45 years old, diagnosed in January of this year with multiple myeloma Stage 3, low risk (none of the negative chromosomal abnormalities.) I am on Revlimid, Velcade and dex therapy with a monthly dose of Zometa. I have had 2 doses of the Zometa so far.
The first time I had Zometa, I experienced chills, rib pain, high temperature (102.7F), night sweats and fatigue. These symptoms started almost exactly 24 hours after the infusion and completely resolved by the 3rd day post-infusion.
I reported my reaction to my doctor and nurses. They all said that this was normal, and that the reaction wouldn't be as severe the next time. They also suggested that I stay very hydrated before, during and after the infusion.
A few days before the next scheduled infusion, I increased my water and Gatorade intake. Again, about 24 hours after the infusion, I ran a fever (though not as high as the first time), had night sweats (but not as severe as the first time) and I was very tired. I had very little bone pain. Again, all symptoms resolved by day 3 post-infusion.
I am hopeful that I will have an even smaller reaction with the next infusion of Zometa and I will be sure to hydrate well again.
Sincerely,
JennyD19
I am 45 years old, diagnosed in January of this year with multiple myeloma Stage 3, low risk (none of the negative chromosomal abnormalities.) I am on Revlimid, Velcade and dex therapy with a monthly dose of Zometa. I have had 2 doses of the Zometa so far.
The first time I had Zometa, I experienced chills, rib pain, high temperature (102.7F), night sweats and fatigue. These symptoms started almost exactly 24 hours after the infusion and completely resolved by the 3rd day post-infusion.
I reported my reaction to my doctor and nurses. They all said that this was normal, and that the reaction wouldn't be as severe the next time. They also suggested that I stay very hydrated before, during and after the infusion.
A few days before the next scheduled infusion, I increased my water and Gatorade intake. Again, about 24 hours after the infusion, I ran a fever (though not as high as the first time), had night sweats (but not as severe as the first time) and I was very tired. I had very little bone pain. Again, all symptoms resolved by day 3 post-infusion.
I am hopeful that I will have an even smaller reaction with the next infusion of Zometa and I will be sure to hydrate well again.
Sincerely,
JennyD19
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JennyD19
Re: Fever after Zometa infusion - is it serious?
Hello Anirudh:
Nancy is right about extending time from fifteen minutes to longer.
When I started my chemo with Revlimid - 25 mg, dexamethasone - 40 mg, and Zometa 4 mg in fifteen minutes, I had fever, excess sweating, and also my entire calf became immobile.
My Zometa dose was reduced to 3 mg and IV injection time to an hour plus. By extending time and reducing the dose I have no problem with Zometa.
I hope it works for your father.
Nancy is right about extending time from fifteen minutes to longer.
When I started my chemo with Revlimid - 25 mg, dexamethasone - 40 mg, and Zometa 4 mg in fifteen minutes, I had fever, excess sweating, and also my entire calf became immobile.
My Zometa dose was reduced to 3 mg and IV injection time to an hour plus. By extending time and reducing the dose I have no problem with Zometa.
I hope it works for your father.
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MMFeb16,15 - Who do you know with myeloma?: Self
- When were you/they diagnosed?: February 16, 2015
- Age at diagnosis: 66
Re: Fever after Zometa infusion - is it serious?
Recent presentation by a local expert indicted that Zometa and Aredia are equal in efficacy based on a Cochrane analysis. Supposedly Cochrane analysis is the most reliable information. Having tried both, It is my experience that Aredia was tolerated much better than Zometa.
The presentation also indicated that the incidence of osteonecrosis of the jaw (ONJ) is much lower with Aredia than with Zometa. I don't know. I did get ONJ, but also used both Zometa and Aredia.
What the doctors don't always explain is that the bone holding our teeth in place is killed 100% of the time with a single bisphosphonate dose. ONJ will occur if there is damage to the gums protecting the bone. The oral surgeon recommends to not eat hard chips or anything that may damage your gums.
The presentation also indicated that the benefit to progression-free survival (PFS) and overall survival (OS) occurs within the first few dosages. There is no additional benefit to PFS and OS from continual dosage. Benefit of continued dosage was stated as being bone protection, especially important if there is active myeloma activity.
I'm just passing the info along. I'd be interested in hearing other research information.
The presentation also indicated that the incidence of osteonecrosis of the jaw (ONJ) is much lower with Aredia than with Zometa. I don't know. I did get ONJ, but also used both Zometa and Aredia.
What the doctors don't always explain is that the bone holding our teeth in place is killed 100% of the time with a single bisphosphonate dose. ONJ will occur if there is damage to the gums protecting the bone. The oral surgeon recommends to not eat hard chips or anything that may damage your gums.
The presentation also indicated that the benefit to progression-free survival (PFS) and overall survival (OS) occurs within the first few dosages. There is no additional benefit to PFS and OS from continual dosage. Benefit of continued dosage was stated as being bone protection, especially important if there is active myeloma activity.
I'm just passing the info along. I'd be interested in hearing other research information.
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faithoverfear - Who do you know with myeloma?: me
- When were you/they diagnosed?: Sept 2014
- Age at diagnosis: 63
Re: Fever after Zometa infusion - is it serious?
Thanks, faithoverfear, for shedding the light in this regard. And yes, bisphosphonates are apparently linked to the necrosis of lower jaw bone. See, for example, this paper:
King, A.E., and Umland, E.M., "Osteonecrosis of the jaw in patients receiving intravenous or oral bisphosphonates," [url]Pharmacotherapy[/url], 2008 (abstract)
But as it says, there's a higher, much higher risk of osteonecrosis of the jaw (ONJ) when the bisphosphonates (Zometa, etc.) are given intravenously than when given oral. The difference is almost close to 40%. So if you're getting the Zometa or Aredia orally, there's approx. only 5% chance you'd get ONJ, but I'm only telling this based on this study only. But it's something you should definitely talk to your oncologist about and if there are any prior precautions to be taken.
Regarding my father's case, we'd already started with the Zometa before I came to know about the risk of ONJ, so there wasn't much I could do. But we are heading to the oral surgeon soon to figure out if there are any early signs and whether we can prevent it somehow.
But all said and done, ONJ is rather rare even if you take bisphosphonates. But you must get it checked regularly.
Thanks again for the caution.
King, A.E., and Umland, E.M., "Osteonecrosis of the jaw in patients receiving intravenous or oral bisphosphonates," [url]Pharmacotherapy[/url], 2008 (abstract)
But as it says, there's a higher, much higher risk of osteonecrosis of the jaw (ONJ) when the bisphosphonates (Zometa, etc.) are given intravenously than when given oral. The difference is almost close to 40%. So if you're getting the Zometa or Aredia orally, there's approx. only 5% chance you'd get ONJ, but I'm only telling this based on this study only. But it's something you should definitely talk to your oncologist about and if there are any prior precautions to be taken.
Regarding my father's case, we'd already started with the Zometa before I came to know about the risk of ONJ, so there wasn't much I could do. But we are heading to the oral surgeon soon to figure out if there are any early signs and whether we can prevent it somehow.
But all said and done, ONJ is rather rare even if you take bisphosphonates. But you must get it checked regularly.
Thanks again for the caution.
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bhardwajanirudh - Name: Anirudh
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: March 14, 2016
- Age at diagnosis: 58
Re: Fever after Zometa infusion - is it serious?
Thanks everyone for the inputs. Sorry I couldn't reply sooner, but yes, my father is doing well now, the cramps have subsided after a couple of injections. They do happen, but nothing severe. The fever is also not that high anymore.
Increasing the duration of the IV for 15-20 minutes to 30-40 minutes has helped considerably, so if someone is going through the side effects, they can consider this option as well, but after talking to their oncologist.
Increasing the duration of the IV for 15-20 minutes to 30-40 minutes has helped considerably, so if someone is going through the side effects, they can consider this option as well, but after talking to their oncologist.
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bhardwajanirudh - Name: Anirudh
- Who do you know with myeloma?: Father
- When were you/they diagnosed?: March 14, 2016
- Age at diagnosis: 58
Re: Fever after Zometa infusion - is it serious?
I couldn't tolerate Zometa. After about 6 months of trying different things (meds to counter the side effects, slowing the infusion rate, etc.), we finally decided to change to Aredia. The turning point was me spending 48 hours in bed after every Zometa dose with horrible bone aching and fever.
Aredia is a 3-hour infusion, which is one of the reasons Zometa is chosen first. But three hours in the infusion chair is a heck of a lot better than 48 hours in bed with pain!
Aredia is a 3-hour infusion, which is one of the reasons Zometa is chosen first. But three hours in the infusion chair is a heck of a lot better than 48 hours in bed with pain!
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Tracy J - Name: Tracy Jalbuena
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2014
- Age at diagnosis: 42
Re: Fever after Zometa infusion - is it serious?
HI Tracy,
You mentioned that you spend 3 hours in the infusion chair to receive Aredia (pamidronate). My monthly pamidronate infusions are delivered via Intermate elastomeric infusion pump (additional information), which means that the nurse simply hooks the pump up and then I get to leave the cancer centre and go about my day (go home, go shopping, etc.) When the three hours are up and the Aredia has completely infused, I simply remove the needle and pump myself at home and dispose of both.
It is really convenient and easy to use, and might be worth looking into if it is available to you. They prefer to use this Aredia delivery method at my cancer centre because it frees up the chemo chair for others.
You mentioned that you spend 3 hours in the infusion chair to receive Aredia (pamidronate). My monthly pamidronate infusions are delivered via Intermate elastomeric infusion pump (additional information), which means that the nurse simply hooks the pump up and then I get to leave the cancer centre and go about my day (go home, go shopping, etc.) When the three hours are up and the Aredia has completely infused, I simply remove the needle and pump myself at home and dispose of both.
It is really convenient and easy to use, and might be worth looking into if it is available to you. They prefer to use this Aredia delivery method at my cancer centre because it frees up the chemo chair for others.
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KarenaD - Name: Karen
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: November 4, 2015
- Age at diagnosis: 54
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