Hi everyone,
Has anyone had the experience of Revlimid/Velcade/dex (RVD) taking a while to work and maybe even making things worse at first?
My mother just finished her first round of RVD (I don't know doses for the Velcade and dex, but her Revlimid is 25 mg for 21 days with 7 off) after becoming refractory to CyBorD (Cytoxan/Velcade/dex). Her IgA level was 800 when she started and it has risen to 1000. Her doctor wants her to do two more cycles before they decide what to do.
If anyone knows of situations where RVD took a while to kick in and make improvements, please do share!
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BeatMyeloma - Name: BeatMyeloma
- Who do you know with myeloma?: My mother
- When were you/they diagnosed?: Jan. 2008
- Age at diagnosis: 54
Re: How long does RVD take to work?
Beat Myeloma,
I may have had similar experiences with a second round of chemo therapy, using RVD.
The first round was with RVD plus Cytoxan [cyclophosphamide] and lasted six months. I had about a two-week break from all treatment after the first round, but during that break, it seemed like my bone pains worsened.
In the first week or so of this second round (weekly VD, and R on 21/28 day schedule; I take 20 mg of dex in pill form), I took narcotic pain killers for a few days and I felt quite fatigued in the later half of the days. But after a couple weeks, the fatigue mostly left.
We also discovered by X-ray that I had new compression fractures in my lower back, and these probably explain those pains. I had other increased pains in my torso, and there was no mention of new injury in those areas, so I'm still puzzled why those pains were definitely worsened just before starting the RVD therapy. But all these pains are subsiding.
Probably the experience that most relates to your mother's experiences is the fatigue, which definitely came with the second round of treatment, and which I never really experienced in my first round of treatment. I have nonsecretory myeloma, with no significant serum light chains with which to gauge progress, and so I can only offer this subjective description.
I hope this all hasn't been confusing to you, but if there are similarities between my experiences and your mother's, I hope and trust she will soon adjust to RVD therapy.
I may have had similar experiences with a second round of chemo therapy, using RVD.
The first round was with RVD plus Cytoxan [cyclophosphamide] and lasted six months. I had about a two-week break from all treatment after the first round, but during that break, it seemed like my bone pains worsened.
In the first week or so of this second round (weekly VD, and R on 21/28 day schedule; I take 20 mg of dex in pill form), I took narcotic pain killers for a few days and I felt quite fatigued in the later half of the days. But after a couple weeks, the fatigue mostly left.
We also discovered by X-ray that I had new compression fractures in my lower back, and these probably explain those pains. I had other increased pains in my torso, and there was no mention of new injury in those areas, so I'm still puzzled why those pains were definitely worsened just before starting the RVD therapy. But all these pains are subsiding.
Probably the experience that most relates to your mother's experiences is the fatigue, which definitely came with the second round of treatment, and which I never really experienced in my first round of treatment. I have nonsecretory myeloma, with no significant serum light chains with which to gauge progress, and so I can only offer this subjective description.
I hope this all hasn't been confusing to you, but if there are similarities between my experiences and your mother's, I hope and trust she will soon adjust to RVD therapy.
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SBarro - Name: Thomas Tonon
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: April, 2014
- Age at diagnosis: 69
Re: How long does RVD take to work?
Thank you for your reply! Maybe in some people treatment just takes awhile to take hold. Mom responded so quickly to CyBorD, but RVD is a different animal. I am glad your pains have subsided – must mean things are looking up! 
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BeatMyeloma - Name: BeatMyeloma
- Who do you know with myeloma?: My mother
- When were you/they diagnosed?: Jan. 2008
- Age at diagnosis: 54
Re: How long does RVD take to work?
In studies with RVD (including those involving newly diagnosed patients), the median time to best response is usually between 2-3 months. This means that half of the patients will achieve maximal response after 2-3 months. Usually, we start seeing some degree of response within the initial few cycles itself.
From the information that you have provided, it appears that there isn't a significant increase in IgA levels at this juncture. I am assuming the other monoclonal studies (UPEP, serum FLC ) are somewhat stable as well. If that is the case, it would be appropriate to continue with the current therapy as the treating physician has stated and monitor the monoclonal protein studies closely.
I would emphasize the importance of looking at the trend of IgA over time rather than prematurely abandoning a regimen on the basis of a single reading.
Good luck.
From the information that you have provided, it appears that there isn't a significant increase in IgA levels at this juncture. I am assuming the other monoclonal studies (UPEP, serum FLC ) are somewhat stable as well. If that is the case, it would be appropriate to continue with the current therapy as the treating physician has stated and monitor the monoclonal protein studies closely.
I would emphasize the importance of looking at the trend of IgA over time rather than prematurely abandoning a regimen on the basis of a single reading.
Good luck.
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Dr. Prashant Kapoor - Name: Prashant Kapoor, M.D.
Beacon Medical Advisor
Re: How long does RVD take to work?
Thank you Dr. Kapoor! Yes, my understanding is that other things look good (and Mom is feeling good and tolerating Revlimid well, besides some fatigue). Ever since her relapse in Feb. 2013, her IgA seems to be a bit stubborn.
That is interesting RVD can take between 2-3 cycles to work. We are very much hoping that her appointment at Mayo in late January will show an improvement!
That is interesting RVD can take between 2-3 cycles to work. We are very much hoping that her appointment at Mayo in late January will show an improvement!
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BeatMyeloma - Name: BeatMyeloma
- Who do you know with myeloma?: My mother
- When were you/they diagnosed?: Jan. 2008
- Age at diagnosis: 54
Re: How long does RVD take to work?
Wanted to give an update. My mother's IgA level is dropping. It's not a huge drop, but it is going in the right direction! Her doctor is pleased, and wants to stay the RVD course. We'll be talking about a second stem cell transplant when we go down for her appointment at Mayo later this month.
Her doctor is pleased, and wants to stay the RVD course. We'll be talking about a second stem cell transplant when we go down for her appointment at Mayo later this month.-
BeatMyeloma - Name: BeatMyeloma
- Who do you know with myeloma?: My mother
- When were you/they diagnosed?: Jan. 2008
- Age at diagnosis: 54
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