[maura82]

High dose cyclophosphamide therapy?

by maura82 on Thu Jun 20, 2013 8:56 pm

Hi there. My mom was diagnosed with primary plasma cell leukemia about a month ago. After undergoing the initial 3 weeks of Velcade therapy the doctor is now having her begin a more aggressive treatment protocol which will involve high doses of cyclophosphamide (cytoxan) administered over 4 days as an inpatient in the hospital every 3 weeks along with the regular Velcade therapy in between. I am extremely concerned about the potential side effects of this regimen and the impact on her quality of life. Has anyone on here undergone it? She currently gets cytoxan once a week for a half hour and it leaves her extremely sick for 2 days so I truly cannot imagine what 96 straight hours of it will do to her. Would love to hear from
Someone with experience. Thanks in advance .

[Dr. Peter Voorhees]

Re: High dose cyclophosphamide therapy?

by Dr. Peter Voorhees on Fri Jun 21, 2013 7:19 am

Dear Maura82,

How old is your mother? Did her plasma cell leukemia respond to the initial course of Cytoxan and Velcade? Also, will the Cytoxan be infused as a 4-day continuous infusion? Several of these 4-day continuous infusion regimens contain several drugs in addition to Cytoxan.

Thanks!

Pete

[maura82]

Re: High dose cyclophosphamide therapy?

by maura82 on Fri Jun 21, 2013 9:20 am

Hi Dr. Voorhees,

Thank you so much for your response. My mother is 66 years old; she presented with primary PCL, multiple lytic lesions, rib fractures, hypercalcemia, renal failure, bilateral pleural effusions (that did not show malignancy on the pet-scan), bone marrow biopsy showed 95% plasma cells. Yes, she responded to the initial course of Cytoxin/Velcade - at first diagnosis, her kappa light chain was 1750, then 45, and now down to 3.4. And yes, the Cytoxan will be a 4-day continuous infusion with other drugs, the names of which I can't remember now (I have them written down at home). It will be every 3 -4 weeks, with Velcade therapy in between. I really do wonder if the effect that this regimen will have on her quality of life will be worth it, given how aggressive PCL is. She is already only 100 pounds. Any thoughts? Is this kind of aggressive chemo really that much more effective?

Again, thank you so much.

Best,
Maura

[Dr. Peter Voorhees]

Re: High dose cyclophosphamide therapy?

by Dr. Peter Voorhees on Sun Jun 23, 2013 5:31 am

My guess is that the regimen is VDT-PACE or something along those lines (DCEP, CVAD). VDT-PACE is considered a standard regimen for plasma cell leukemia, typically as an initial induction chemotherapy prior to a transplant. It is a difficult treatment, though, especially as you get older, and it would seem that your mom cannot afford to lose much weight. This is a tough decision, and I am not sure I can provide good guidance from afar. It would seem that your mom has had a terrific response to the first round of chemotherapy. So, I think you need to get more clarity from her doctors as to why the change in therapy is being made and what the risks and benefits of staying the course with the current regimen are vs. switching to VDT-PACE.

Let us know how things go.

Thanks and good luck!

Pete V.