My husband was diagnosed IGA kappa with the t 4;14 abnormality. His disease was unresponsive to Velcade and dex, but obtained a partial response to Revlimid/dex prior to transplant and then a VGPR after tandem transplants. My question is regarding the new studies showing that Velcade eridicates the poor prognosis of the t 4;14. Does the patient need to respond to Velcade in order for it to overcome the t 4;14, or did "just the giving it to him" do the trick? My husband is currently on Revlimid (news) maintenance, but not Velcade (news) b/c our doctor finds it unnecessary b/c his disease was stable to it.
Thank you.
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Readertk - Name: Tiffany
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: December 2009
- Age at diagnosis: 42
Re: Husband with t 4;14
t(4;14) by definition is high risk disease. There have been a number of studies that suggested bortezomib (Velcade) would overcome the "high-risk" nature of that genetic abnormality. But t(4;14) and its bearing on risk remains a moving target. More recently, studies indicate that Velcade provides a better outcome, but does not completely "change" someone from high risk to standard risk. This is especially true of individuals with paired del13 abnormalities.
What is important to keep in mind about all of these studies is that they look at populations of people- not individual patients. Everyong with myeloma has their own unique disease with their own course. In the case of your husband, he was refractory to Velcade therapy initially (so, Velcade had little effect on his disease). This in-off-itself suggests your husdand may have a more difficult disease to control over the long term. His treatment with lenalidomide (Revlimid) was succesful with a good response. With his transplant he achieved a VGPR and is now on maintenance Rev. Everything appears to be going well- and that is what you both should focus on. With his high-risk and minimal residual disease after transplant maintenance therapy is appropriate (two large phase III studies have both shown that maintenance therapy nearly doubles progression free survival and one has already demonstrated an overall survival benefit). You will need to continue to monitor carefully while on maintenance therapy. At this point, only time will dictate his disease course and the time that passes before he progresses.
There is a lot of excitement regarding two drugs that will hopefully be approved for relapsed/refractory disease -- carfilzomib (news) and pomalidomide (news) -- before your husband relapses. Further, clinical trials may be available in your area which are important for myeloma therapy for today and defining new therapies for tomorrow and should always be considered if appropriate.
Again, you are in a good spot with disease control, good therapy, and hopefully prolonged period of time before you have to start being overly concerned about alternate therapies. Please enjoy your Labor day.
What is important to keep in mind about all of these studies is that they look at populations of people- not individual patients. Everyong with myeloma has their own unique disease with their own course. In the case of your husband, he was refractory to Velcade therapy initially (so, Velcade had little effect on his disease). This in-off-itself suggests your husdand may have a more difficult disease to control over the long term. His treatment with lenalidomide (Revlimid) was succesful with a good response. With his transplant he achieved a VGPR and is now on maintenance Rev. Everything appears to be going well- and that is what you both should focus on. With his high-risk and minimal residual disease after transplant maintenance therapy is appropriate (two large phase III studies have both shown that maintenance therapy nearly doubles progression free survival and one has already demonstrated an overall survival benefit). You will need to continue to monitor carefully while on maintenance therapy. At this point, only time will dictate his disease course and the time that passes before he progresses.
There is a lot of excitement regarding two drugs that will hopefully be approved for relapsed/refractory disease -- carfilzomib (news) and pomalidomide (news) -- before your husband relapses. Further, clinical trials may be available in your area which are important for myeloma therapy for today and defining new therapies for tomorrow and should always be considered if appropriate.
Again, you are in a good spot with disease control, good therapy, and hopefully prolonged period of time before you have to start being overly concerned about alternate therapies. Please enjoy your Labor day.
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Husband with t 4;14
Thank you for the detailed response to my question. Our doctor is recommending Vorinostat or Vidaza when Kirk relapses b/c he believes these drugs would better target the t 4;14 problem. What are your thoughts on these drugs compared to Carf or Pom?
Kirk presented with calcium level 13.6, hemoglobin at 8.0, and beta 2 at 4, and extensive bone damage throughout most of the bones in his body. He was 42 yrs of age. I just wanted to give you all our info.
Once again, thank you for your time.
Tiffany
Kirk presented with calcium level 13.6, hemoglobin at 8.0, and beta 2 at 4, and extensive bone damage throughout most of the bones in his body. He was 42 yrs of age. I just wanted to give you all our info.
Once again, thank you for your time.
Tiffany
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Readertk - Name: Tiffany
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: December 2009
- Age at diagnosis: 42
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