Hi,
My dad is at his 5-year milestone from diagnosis. He has had 2 autologous stem cell transplants and has tried pretty much all novel treatments. His multiple myeloma is the light chain type. His creatinine started to spike (hovering at 4 for 3 weeks), his electrolytes have been normal, but his hemoglobin has dropped. The only symptom he has is being tired from anemia.
So the plan is to admit him to the hospital, do some dialysis, and then high-dose cyclophosphamide (Cytoxan). There are no stem cells to help recover from the Cytoxan bomb. I am trying my best to prepare. Since he lives so far away, they are requiring he stay with me as his blood counts plummet. What can we expect in terms of the treatment's effectiveness and side effects?
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Re: Treatment with high-dose Cytoxan: what to expect?
Hi Sun45,
I'm sorry to hear about your dad's situation.
You may wish to read through this article regarding high-dose Cytoxan salvage therapy. The article frankly discusses the outcomes and some of the side effects (fever, neutropenia, etc) of a small cohort of patients that underwent this salvage therapy. The article also suggests that high-dose Cytoxan salvage therapy should be used a bridge therapy to another planned therapy.
Rivell, GL, et al, "Effectiveness and safety of high-dose cyclophosphamide as salvage therapy for high-risk multiple myeloma and plasma cell leukemia refractory to new biological agents," American Journal of Hematology, Aug 2011 (full text of article)
I understand from an earlier post that your dad has tried Darzalex, but with no success. Just which drug combinations has he already tried?
Also, has he sought a second opinion from a different specialist and has your dad considered a clinical trial with one of the newer classes or combinations of myeloma drugs under investigation for refractory patients?
https://clinicaltrials.gov/ct2/results?term=myeloma+refractory&recr=Open
I'm sorry to hear about your dad's situation.
You may wish to read through this article regarding high-dose Cytoxan salvage therapy. The article frankly discusses the outcomes and some of the side effects (fever, neutropenia, etc) of a small cohort of patients that underwent this salvage therapy. The article also suggests that high-dose Cytoxan salvage therapy should be used a bridge therapy to another planned therapy.
Rivell, GL, et al, "Effectiveness and safety of high-dose cyclophosphamide as salvage therapy for high-risk multiple myeloma and plasma cell leukemia refractory to new biological agents," American Journal of Hematology, Aug 2011 (full text of article)
I understand from an earlier post that your dad has tried Darzalex, but with no success. Just which drug combinations has he already tried?
Also, has he sought a second opinion from a different specialist and has your dad considered a clinical trial with one of the newer classes or combinations of myeloma drugs under investigation for refractory patients?
https://clinicaltrials.gov/ct2/results?term=myeloma+refractory&recr=Open
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Treatment with high-dose Cytoxan: what to expect?
Hi Sun45,
As is so often the case, Multibilly makes some really good suggestions, asks some helpful question, and points to some valuable resources.
I have just a couple of questions that may help you as you try to figure out how things might go for your father.
One question is whether the high-dose cyclophosphamide he will be receiving will be the only myeloma therapy he'll be given, or will it be given as part of a multi-drug regimen, such as DCEP or PACE (DCEP = dexamethasone, cyclophosphamide, etoposide, and cisplatin, PACE = cisplatin, doxorubicin, cyclophosphamide, and etoposide).
The other question is just a clarification to make sure there's no misunderstanding. In particular, is it clear that the purpose of the high-dose Cytoxan is treatment, or is it possible that your father is being prepared for a third transplant, and the Cytoxan is for stem cell mobilization and harvesting prior to the third transplant?
In any case, I hope all goes well for your father.
As is so often the case, Multibilly makes some really good suggestions, asks some helpful question, and points to some valuable resources.
I have just a couple of questions that may help you as you try to figure out how things might go for your father.
One question is whether the high-dose cyclophosphamide he will be receiving will be the only myeloma therapy he'll be given, or will it be given as part of a multi-drug regimen, such as DCEP or PACE (DCEP = dexamethasone, cyclophosphamide, etoposide, and cisplatin, PACE = cisplatin, doxorubicin, cyclophosphamide, and etoposide).
The other question is just a clarification to make sure there's no misunderstanding. In particular, is it clear that the purpose of the high-dose Cytoxan is treatment, or is it possible that your father is being prepared for a third transplant, and the Cytoxan is for stem cell mobilization and harvesting prior to the third transplant?
In any case, I hope all goes well for your father.
Re: Treatment with high-dose Cytoxan: what to expect?
Great, clarifying questions Cheryl. I shouldn't have automatically assumed that this was going to be a Cytoxan-only treatment without a transplant in mind.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Treatment with high-dose Cytoxan: what to expect?
I genuinely appreciate you guys weighing in. There was a change in plans since my earlier post. They are going to scrap the Cytoxan and dialysis (they were not prepping for transplant; he's had two autologous transplants, and his disease and renal health are too unstable for an allogeneic transplant).
The plan now is IV Solu-Medrol (methylprednisolone) for a couple days, then start Farydak (panobinostat), Darzalex, Velcade, and I'm sure dex.
As I reflect on the past 5 years, he started as smoldering, progressed to low genetic risk, then 1 autologous transplant, about 1 year remission, then another auto transplant, progressed to light chain high-risk refractory to Revlimid, Velcade and tried Pomalyst in almost all combinations and I'm sure I'm missing one!
We trust his hematologist-oncologist. We're at the University of Minnesota (go Gophers!).
I am an RN, and am realistic. I appreciate the interaction with people who can relate to the roller coaster!
The plan now is IV Solu-Medrol (methylprednisolone) for a couple days, then start Farydak (panobinostat), Darzalex, Velcade, and I'm sure dex.
As I reflect on the past 5 years, he started as smoldering, progressed to low genetic risk, then 1 autologous transplant, about 1 year remission, then another auto transplant, progressed to light chain high-risk refractory to Revlimid, Velcade and tried Pomalyst in almost all combinations and I'm sure I'm missing one!
We trust his hematologist-oncologist. We're at the University of Minnesota (go Gophers!).
I am an RN, and am realistic. I appreciate the interaction with people who can relate to the roller coaster!
Re: Treatment with high-dose Cytoxan: what to expect?
That's an interesting drug combination. Early studies have show that there is lot of synergistic activity between Farydak and and Darzalex, as well as between Farydak and Velcade. Wishing your dad all the best.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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