Hi all,
My mother started her Revlimid, Velcade, and dexamethasone (RVD) regimen due to high kappa-lambda ratio. She has 2-week cycle wherein she takes Velcade on day 1 along with 20 mg dexamethasone. She takes oral 20 mg dexamethasone on days 2, 3 and 4. She also takes Revlimid 10 mg along with this. She doesn't take any steroid during her second week.
It would be very helpful if someone has experience with such high dose steroid along with Revlimid in a single week.
I browsed through the forum and it seems normally 40 mg of steroid is given in a week. Is that true? Should I be concerned that she is taking a higher dose (80 mg versus 40 mg) of dexamethasone that is normal?
Also, will splitting the steroid 40 mg per week instead of 80 mg reduce the effectiveness? Her oncologist thinks this is the best way to reduce the ratio.
Thanks for any help.
Forums
Re: High-dose dexamethasone with Revlimid & Velcade (RVD)
Just an update to my above post. My mother's oncologist had stopped her Revlimid since a year due to low WBC counts, but he started it again as the ratio increased. He says he will look at the CBC results after 15 days and decide whether to continue Revlimid or not. She does not take any Velcade or dexamethasone during the second week.
Thanks again.
Thanks again.
Re: High-dose dexamethasone with Revlimid & Velcade (RVD)
I was on a 21-day cycle of cyclophosphamide, thalidomide, and dexamethasone (CTD), with dex on days 1, 2, 3, 4 and 12, 13, 14 and 15, 40 mg per day.
I did 6 cycles over 4 months, followed by radiotherapy for 10 days to an iliac bone plasmacytoma. Achieved complete remission but did not have a stem cell transplant.
Been in remission for just over a year and have ongoing side effects. Peripheral neuropathy to feet, legs and pelvis, and maybe a bit in my hands. Also got radiation colitis followed by sepsis and had to have my sigmoid colon removed. As a result, I've got two stomas. I've got cognitive impairment and ongoing fatigue and pain.
Ent ded though, which is nice.
Regards,
Taff
I did 6 cycles over 4 months, followed by radiotherapy for 10 days to an iliac bone plasmacytoma. Achieved complete remission but did not have a stem cell transplant.
Been in remission for just over a year and have ongoing side effects. Peripheral neuropathy to feet, legs and pelvis, and maybe a bit in my hands. Also got radiation colitis followed by sepsis and had to have my sigmoid colon removed. As a result, I've got two stomas. I've got cognitive impairment and ongoing fatigue and pain.
Ent ded though, which is nice.
Regards,
Taff
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Taff - Name: Taff
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: October 2016
- Age at diagnosis: 61
Re: High-dose dexamethasone with Revlimid & Velcade (RVD)
Hi Taff,
Thanks for your response. I am sorry to hear about the side effects you faced as a result of the high-dose steroid.
My mother is taking dexamethasone since more than a year, but it's the first time on such a high dose. Since the last couple months she was on 60 mg dexamethasone and had really bad crash days.
Ruchi
Thanks for your response. I am sorry to hear about the side effects you faced as a result of the high-dose steroid.
My mother is taking dexamethasone since more than a year, but it's the first time on such a high dose. Since the last couple months she was on 60 mg dexamethasone and had really bad crash days.
Ruchi
Re: High-dose dexamethasone with Revlimid & Velcade (RVD)
My sister's Velcade, Revlimid, and dexamethasone regimen was changed at some point from 28 days to a two-week cycle. She also had a higher dose of dexamethasone in the shorter cycle. I think this is standard. I do not know the rationale for it.
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Gala - Name: Gala
- Who do you know with myeloma?: sister, LgA-k
- When were you/they diagnosed?: December 2015
- Age at diagnosis: 48
Re: High-dose dexamethasone with Revlimid & Velcade (RVD)
Ruchi,
The sort of dexamethasone doses your mother is receiving are similar to those that were used when the Revlimid, Velcade, and dexamethasone regimen was first developed. See, for example, this paper which is one of the first to report results with RVD in newly diagnosed myeloma patients:
http://www.bloodjournal.org/content/116/5/679.long
You'll see that the doses used in the study are similar to what your mother is getting.
In the U.S., lower dexamethasone doses are being used more frequently because of a study that was done showing that lower doses have higher overall survival when used in newly diagnosed patients, even though the lower doses do not lead to responses that are as deep. Here's the study:
https://www.ncbi.nlm.nih.gov/pubmed/19853510
It's my sense, however, that higher dexamethasone doses are still used regularly outside the U.S., particularly in countries where some of the newer myeloma treatments are not yet available, or where treatment is given for shorter periods of time than in the U.S. for cost reasons. This is done especially in the case of relapsed patients, where it is felt the higher-dose of dex will have a net survival benefit given that the higher dose increases depth of response, and patients who have made it to relapse are (perhaps) less likely to experience life threatening side effects related to dexamethasone.
As an aside, I did not get the sense that the side effects Taff experienced were due to the dexamethasone in her CTD treatment regimen. I also didn't think she meant to imply that. The peripheral neuropathy she developed most likely was due to the thalidomide, and perhaps the cyclophosphamide, in her treatment regimen, and the radiation was responsible for the sepsis and surgery she had to undergo.
Best of luck to your mother,
Jonah
The sort of dexamethasone doses your mother is receiving are similar to those that were used when the Revlimid, Velcade, and dexamethasone regimen was first developed. See, for example, this paper which is one of the first to report results with RVD in newly diagnosed myeloma patients:
http://www.bloodjournal.org/content/116/5/679.long
You'll see that the doses used in the study are similar to what your mother is getting.
In the U.S., lower dexamethasone doses are being used more frequently because of a study that was done showing that lower doses have higher overall survival when used in newly diagnosed patients, even though the lower doses do not lead to responses that are as deep. Here's the study:
https://www.ncbi.nlm.nih.gov/pubmed/19853510
It's my sense, however, that higher dexamethasone doses are still used regularly outside the U.S., particularly in countries where some of the newer myeloma treatments are not yet available, or where treatment is given for shorter periods of time than in the U.S. for cost reasons. This is done especially in the case of relapsed patients, where it is felt the higher-dose of dex will have a net survival benefit given that the higher dose increases depth of response, and patients who have made it to relapse are (perhaps) less likely to experience life threatening side effects related to dexamethasone.
As an aside, I did not get the sense that the side effects Taff experienced were due to the dexamethasone in her CTD treatment regimen. I also didn't think she meant to imply that. The peripheral neuropathy she developed most likely was due to the thalidomide, and perhaps the cyclophosphamide, in her treatment regimen, and the radiation was responsible for the sepsis and surgery she had to undergo.
Best of luck to your mother,
Jonah
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Jonah
Re: High-dose dexamethasone with Revlimid & Velcade (RVD)
Thank you so much for the helpful information. My mother is not in US, she is currently in India. Also, she is being treated by a hematologist and not a myeloma specialist. That's the reason I was a bit concerned about the doses.
Thanks again,
Ruchi
Thanks again,
Ruchi
Re: High-dose dexamethasone with Revlimid & Velcade (RVD)
Hi Ruchi,
I never had a crash after taking dex, and I never got manic while on it. I did find that I sometimes talked louder without realising, or spoke a bit more. I did get some very minor psychotic incidences, seeing things that weren't there for an instant, or hearing things that weren't said, but they were literally momentary flashes.
From time to time I take prednisolone with antibiotics for my COPD. Again 40 mg daily for 5 days. I've noticed increased appetite with them and the same loudness when talking. Didn't have an increase in appetite when on CTD (cyclophosphamide, thalidomide, and dexamethasone).
I never had a crash after taking dex, and I never got manic while on it. I did find that I sometimes talked louder without realising, or spoke a bit more. I did get some very minor psychotic incidences, seeing things that weren't there for an instant, or hearing things that weren't said, but they were literally momentary flashes.
From time to time I take prednisolone with antibiotics for my COPD. Again 40 mg daily for 5 days. I've noticed increased appetite with them and the same loudness when talking. Didn't have an increase in appetite when on CTD (cyclophosphamide, thalidomide, and dexamethasone).
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Taff - Name: Taff
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: October 2016
- Age at diagnosis: 61
Re: High-dose dexamethasone with Revlimid & Velcade (RVD)
Hi Jonah,
Apart from the fact that she's a he, you're spot on.
Apart from the fact that she's a he, you're spot on.
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Taff - Name: Taff
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: October 2016
- Age at diagnosis: 61
Re: High-dose dexamethasone with Revlimid & Velcade (RVD)
Ruchi,
I was on that same dosage during my induction for six months; 20 mg 4 times a week for a total of 80 mg a week. I did that for two weeks on and one week off in a three-week cycle.
I didn't realize at the time that it was such a high weekly dose. I did gain some weight and had sleep issues. I didn't have the personality changes they said I could get, although I was a bit more prone to crying.
Good luck to your mom.
I was on that same dosage during my induction for six months; 20 mg 4 times a week for a total of 80 mg a week. I did that for two weeks on and one week off in a three-week cycle.
I didn't realize at the time that it was such a high weekly dose. I did gain some weight and had sleep issues. I didn't have the personality changes they said I could get, although I was a bit more prone to crying.
Good luck to your mom.
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Janet1520
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