[LadyLib]

How many chemo cycles before SCT?

by LadyLib on Wed Oct 02, 2013 1:00 am

My husband has been given conflicting stories. One doctor says 6 months of chemo - Velcade/​dex/​Cytoxan ... The other doctor said he should be ready to go after 4 months. How long did you go? He had a 85% reduction in light chains after one cycle. He appears to be responding well, so why 6 months?

[asaryden]

Re: How many chemo cycles before SCT?

by asaryden on Wed Oct 02, 2013 7:14 am

Hi LadyLib,
As you probably know there is not a total consensus among doctors when it comes to treatment of multiple myeloma. I had the same induction as your husband, for 3 cycles, before an auto transplant in 2010. My urine lambda light chains numbers went from 18 000 to 460 after the first cycle. It went slower after that.
If I had known then what I know now I would have preferred to have a few more cycles as research indicate that it is better to have as low numbers as possible (within reasonable limits) before the transplant. Probably more important for high risk patients than others.
Best of luck to you and your husband!
Åsa

[Nancy Shamanna]

Re: How many chemo cycles before SCT?

by Nancy Shamanna on Wed Oct 02, 2013 8:41 am

HI LadyLib, Of course everyone's disease and treatment is different, but wouldn't your husband's length of treatment on CyBorD be dependent upon how well he responds to treatment? My induction chemo with Velcade/dex only went on for four cycles, although it more standardly was six cycles. That was because I responded very well to treatment, and also because my oncologist was concerned about the problems with neuropathy which quite often occur with the use of Velcade. So I just assume that some of one's treatment is determined as one goes along, rather than being a set amount, but of course I don't know that much about how different treatment centres approach this.

[Dr. Adam Cohen]

Re: How many chemo cycles before SCT?

by Dr. Adam Cohen on Wed Oct 02, 2013 5:57 pm

As mentioned above, there is no complete consensus about this, and the number of cycles used has varied in the different clinical trials of induction therapy before transplant (though was always at least 3). I tell my patients going to SCT that they will get between 3-6 cycles of induction, depending on their initial burden of disease, how well they are responding, and their tolerability of the treatment. It's true that we are trying to get deeper responses pre-SCT (ideally a VGPR or better - meaning a >90% reduction in the myeloma protein levels from baseline), but not at the cost of severe neuropathy or other treatment-related toxicities that may impact long-term quality of life, especially now that we can use consolidation and maintenance treatments to continue to improve responses post-SCT. So this remains an individualized decision and may differ from doctor to doctor (or patient to patient).

[WeatherNurse13]

Re: How many chemo cycles before SCT?

by WeatherNurse13 on Thu Oct 03, 2013 10:50 am

When I was diagnosed last year, I had a heavy tumor burden and was told I would have 4-6 rounds of VDT PACE. I had a VGPR after 2, had a 3rd, then had to back off of the heavy stuff and switch to CyBorD. I had only one cycle of CyBorD, but a total of 4 cycles in all. At re-staging, I had a CR and was in a perfect place for a transplant. So treatment changes with how your body responds. My doctors were all astonished about my remarkable response in 3 months time. So the big gun therapy did what it was designed to do with the powerful direction of the Big Man upstairs.

As the members of my support group remind each other, myeloma is a very individualized disease.

[NStewart]

Re: How many chemo cycles before SCT?

by NStewart on Thu Oct 03, 2013 1:53 pm

I had an induction regimen of Rev 15 mg and Dex 40 mg and responded to it very quickly and well. My oncologist told me that the optimal time for transplant with this regimen was between 6 and 18 months. Because I was working full time, am single and my caregiver lived 1000+ miles away and also was working full time, I opted for a time that was after 8 months. By doing this my employer was able to find someone to replace me while I was out on FMLA, my sister could make arrangements with her employer and I had plenty of time to respond well to treatment.

Selfishly I also decided to do it at the beginning of the year because the weather is the worst in Philadelphia during January and February. By being off from work I wouldn't have to worry about getting to work when traveling was bad. That worked out well because we had 2 blizzards that pretty much shut Philadelphia down while I was in the hospital for the transplant. I also didn't want to be in the hospital or sick during the Thanksgiving and Christmas holidays.

This worked out well for me. I had no problems with harvesting my stem cells, 1 day, and no problems really with the transplant. I have since learned that people who take Revlimid can end up with difficulty harvesting because of its effect on the blood cells. Fortunately I didn't know this at the time.

[tropicdiver]

Re: How many chemo cycles before SCT?

by tropicdiver on Thu Oct 03, 2013 2:27 pm

Gosh, I am astonished at how little I know about the cancer I have. I have read so many stories about how about the lack of 'quality of life' can be during the SCT and had decided it wasn't for me and just figured I would be on this maintenance cycle until I either passed or improved, where I could take a break for a while.

I have had little luck getting very clear answers from my Oncologist/Hemotologist and after reading the above comments, I feel even more clueless about Multiple Myeloma.

Everytime I go in after blood work, I am told all my numbers look great and am doing well. The only problem I am really dealing with is Nueropathy in my feet at this time and I don't feel too well for 3 or so days after my Velcade, but I always bounce back and feel fine, after the 3 or so do days pass.

Is SCT a requirement to treating Multiple Myeloma and can I enjoy some quality of life and remain on a maintenance cycle?

[Gilbert]

Re: How many chemo cycles before SCT?

by Gilbert on Thu Oct 03, 2013 3:53 pm

2weeks of radiation 2 28 day cycle of decadron 40 mg and Revlimid
Once a week for 5 months of Velcade One 8 hr dose of Melphelan
2 weeks injections of Neupogen,coolected 22 million stem cells I was ready for first transplant
7/10/10. Second transplant 12/9/10
No meds being taken now I am non- secretory multiple myeloma guy 64
Pet Scan every 6 months, and so it goes
Stay Strong

[Nipon Ginko]

Re: How many chemo cycles before SCT?

by Nipon Ginko on Fri Oct 04, 2013 1:35 am

This is in response to "Tropical divers" inquire - I am like you don't know much about this multiple myeloma except what l pick up on sites like this and the little bits and pieces l get from my oncologist . I have Never had a stem cell transplant of any kind - went thru 10 months of treatment in 2004 with thalidomide. & Dex and that was the last treatment for multiple myeloma I have had (l was told then that l had maybe 3 yrs to live , decided that was not enough time so l'm still here) - don't get me wrong l have plenty of problems - my spine is all screwed up and my feet are so bad l can hardly walk -and l came down with prostrate cancer about 2 years ago , ; weigh to much due to not being able to walk and get exercize , it takes me a week to accomplish tasks that used to take a couple hours, other than that l'm just wonderful. N.G.

[Wayne K]

Re: How many chemo cycles before SCT?

by Wayne K on Fri Oct 04, 2013 10:42 am

I did Velcade and responded well to it. My doctor waited to start the SCT preliminary until I appeared to be holding on to remission. I suspect this is a good idea because the procedure isn't something that happens overnight. I spent about 2 1/2 months overall getting ready with everything necessary leading up to the procedure.