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Re: Induction therapy to maintenance therapy - a transition
Thanks for your update, K_Shash. It sounds like you're making the transition to maintenance therapy rather well.
Re: Induction therapy to maintenance therapy - a transition
Hi Ellen,
It has been only 4 or 5 days since stopping the magnesium. I can now confirm that the magnesium was the culprit, at least in my case. My bowel movements are regular and I do not have the diarrhea after every meal anymore.
If and only if I experience cramps again, I will have to take a moderate dose of magnesium, less than the 2 X 500 mg I was taking daily.
Thanks, TerryH. I hope I can settle into a maintenance routine soon and have my kappa and kappa-lambda ratio in the normal range.
It has been only 4 or 5 days since stopping the magnesium. I can now confirm that the magnesium was the culprit, at least in my case. My bowel movements are regular and I do not have the diarrhea after every meal anymore.
If and only if I experience cramps again, I will have to take a moderate dose of magnesium, less than the 2 X 500 mg I was taking daily.
Thanks, TerryH. I hope I can settle into a maintenance routine soon and have my kappa and kappa-lambda ratio in the normal range.
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K_Shash - Name: K_Shash
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: November 2014
- Age at diagnosis: 67
Re: Induction therapy to maintenance therapy - a transition
Hell K_Shash:
FLC kappa and lambda can be influenced by several factors.
In my indolent myeloma stage, I had a serum free kappa of 473 mg/dl and kappa/lambda ratio of 40.91. Now, after eleven cycles of Revlimid, dex and once in three month Zometa, I have no M-spike, but immunoelectrophoresis shows "suggestive of monoclonal gammopathy - positive for IgG and kappa isotope.
My serum free kappa is 5.63 mg/dl and the ratio is 2.47. It keeps fluctuating in this lower range since last three months.
Today I read that fluctuations in FLC kappa and ratio could happen due to a person suffering from rheumatoid arthritis, auto immune disease, pulmonary disease and other nerve related issues.
How much should one worry about free light chain reading in myeloma? I have auto immune disease and arthritis.
FLC kappa and lambda can be influenced by several factors.
In my indolent myeloma stage, I had a serum free kappa of 473 mg/dl and kappa/lambda ratio of 40.91. Now, after eleven cycles of Revlimid, dex and once in three month Zometa, I have no M-spike, but immunoelectrophoresis shows "suggestive of monoclonal gammopathy - positive for IgG and kappa isotope.
My serum free kappa is 5.63 mg/dl and the ratio is 2.47. It keeps fluctuating in this lower range since last three months.
Today I read that fluctuations in FLC kappa and ratio could happen due to a person suffering from rheumatoid arthritis, auto immune disease, pulmonary disease and other nerve related issues.
How much should one worry about free light chain reading in myeloma? I have auto immune disease and arthritis.
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MMFeb16,15 - Who do you know with myeloma?: Self
- When were you/they diagnosed?: February 16, 2015
- Age at diagnosis: 66
Re: Induction therapy to maintenance therapy - a transition
Hi K_Shash,
Sorry for the delayed post here, following up on your latest update. I've been traveling and have fallen way behind in reading the Forum, unfortunately.
A couple of things you mentioned in your update resonate with me. One is the need to adjust your Revlimid dose, depending on side effects and on how effective (or not) the dose is. That's something I've gone through with my Revlimid (only) maintenance during the time since I started it 2 1/2 years ago. As far as I can tell, it's an art and a balancing act. I think my oncologist's strategy is to keep me at the highest Revlimid level that I can tolerate. Over time, that level has decreased. Now it is 5mg daily for 21 "on" days followed by 7 "off" days per cycle.
Another thing that's similar, which MMFeb16, 15 addressed, is that my FLC numbers have bounced around a bit. Mostly my lambda number has been at the bottom of the normal range or below. Because that's such a small number, it has a big effect on the kappa-lambda ratio. So sometimes that ratio is in the normal range, and sometimes outside. My oncologist seems to think that myeloma is suppressing the lambda FLC in my case - that the low lambda and the higher ratio are an indication that something is going on, even though my kappa FLC numbers are almost always in the normal range.
But the key thing is that he's not worried by one test or two where the kappa-lambda ratio is slightly high. Instead, he's looking for a trend across three or more (monthly) tests. So far, I've been lucky and have had the k/l ratio bounce back down within a couple months after each high reading.
Finally, I am dealing with Revlimid + magnesium diarrhea too. My cardiac electrophysiologist told me earlier this month to restart magnesium to help with the cardiac arrhythmia and atrial fibrillation that I've been experiencing. Side effects of meds used to combat side effects of other meds ...
Best wishes to you!
Mike
Sorry for the delayed post here, following up on your latest update. I've been traveling and have fallen way behind in reading the Forum, unfortunately.
A couple of things you mentioned in your update resonate with me. One is the need to adjust your Revlimid dose, depending on side effects and on how effective (or not) the dose is. That's something I've gone through with my Revlimid (only) maintenance during the time since I started it 2 1/2 years ago. As far as I can tell, it's an art and a balancing act. I think my oncologist's strategy is to keep me at the highest Revlimid level that I can tolerate. Over time, that level has decreased. Now it is 5mg daily for 21 "on" days followed by 7 "off" days per cycle.
Another thing that's similar, which MMFeb16, 15 addressed, is that my FLC numbers have bounced around a bit. Mostly my lambda number has been at the bottom of the normal range or below. Because that's such a small number, it has a big effect on the kappa-lambda ratio. So sometimes that ratio is in the normal range, and sometimes outside. My oncologist seems to think that myeloma is suppressing the lambda FLC in my case - that the low lambda and the higher ratio are an indication that something is going on, even though my kappa FLC numbers are almost always in the normal range.
But the key thing is that he's not worried by one test or two where the kappa-lambda ratio is slightly high. Instead, he's looking for a trend across three or more (monthly) tests. So far, I've been lucky and have had the k/l ratio bounce back down within a couple months after each high reading.
Finally, I am dealing with Revlimid + magnesium diarrhea too. My cardiac electrophysiologist told me earlier this month to restart magnesium to help with the cardiac arrhythmia and atrial fibrillation that I've been experiencing. Side effects of meds used to combat side effects of other meds ...
Best wishes to you!
Mike
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mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: Induction therapy to maintenance therapy - a transition
Dear Mike and K_Shash:
I do not see my hematologist worried about FLC. I am the one worried as I like to be in CR as per definition.
I like to get out of Revlimid plus dex or get it reduced. My hematologist suggests one more month. I am on 25 mg Revlimid 21 days and 16 mg dex once weekly. It started with 40 mg dex; it was reduced to 20 mg after one cycle and further reduced to 16 mg from ninth cycle.
I hope I can go back to Revlimid alone at a lower dose for maintenance.
Thank you.
I do not see my hematologist worried about FLC. I am the one worried as I like to be in CR as per definition.
I like to get out of Revlimid plus dex or get it reduced. My hematologist suggests one more month. I am on 25 mg Revlimid 21 days and 16 mg dex once weekly. It started with 40 mg dex; it was reduced to 20 mg after one cycle and further reduced to 16 mg from ninth cycle.
I hope I can go back to Revlimid alone at a lower dose for maintenance.
Thank you.
-
MMFeb16,15 - Who do you know with myeloma?: Self
- When were you/they diagnosed?: February 16, 2015
- Age at diagnosis: 66
Re: Induction therapy to maintenance therapy - a transition
Hi MMFeb16,15
I am concerned about my kappa readings bouncing around 30 mg/dL. The last one was over 33, but the K/L ratio had dropped to 'within the normal range'. I assume that my oncologist is 'fine tuning' the Revlimid only maintenance dose to see if the 21 days x 10 mg and 7 days off helps reduce the kappa reading. He has not been too worried about this level (30 +/- of kappa) but may be the jump from 27.6 to 33.2 warranted a change. My oncologist is reluctant to add dex because of its long-term side effects. It is good to know that one's long-term health is still a major concern!
Hi Mike,
I am going through the same 'fine tuning' of the maintenance dose of Revlimid that you went through. Yes, I could not tolerate the 15 mg Revlimid for 21 days on and 7 days off after the dex was dropped completely from my drug regimen. I had the Revlimid rash on both my legs after 11 days of the daily 15 mg Revlimid. Therefore, the 15 mg on alternate days was tried. I hope the usual 10 mg Revlimid dose (21 days on and 7 days off) is more effective and that I can tolerate it. My oncologist, too, is essentially trying to put me on the highest Revlimid dose that I can tolerate.
GI problems: I am lucky and do not have any heart-related problems such as high BP or arrhythmia. However, I have had a severe acidosis for a long time. I cannot tolerate Motrin (ibuprofen) or aspirin and even the daily 81 mg coated aspirin seems to cause a bit of diarrhea. Nothing like that caused by the magnesium, though. I have not experienced any major cramps after dropping the daily 2 x 500 mg of the magnesium. I would try a smaller dose of magnesium if I do get the muscle cramps again.
On the positive side, I have been able to manage an active life and I do not feel the severe exhaustion after a short walk up a hill and I do not seem to need to lie down during the day. That was the case toward the end of my induction phase of the RVD treatment and during the dex days. I can manage long walks now and even a round of golf without riding a cart. I have not tried carrying a golf bag yet and instead used a 'push cart', only to avoid any shoulder pain. I really need the exercise (trying to settle into a 2 rounds of golf per week) to be able to sleep well and just have that overall 'feel good' sense.
I am glad you were traveling and had managed the travel to California and topped it with the hike up the Half Dome last year. I must be feeling healthier because I had a face mask but didn't even think of putting it on during the golf I played in the strong wind yesterday. However, I am almost paranoid about getting any infections and I have decided to avoid any air travel. I read the posts on the topic of the Alaska Airlines treatment of a myeloma patient and I have decided to travel only by a car, at least for now. I can manage to drive 3-hour stretches at a time and I can cover most of California. I had to travel a lot in my career (Europe, Asia and Central America and the numerous domestic trips) and I do not miss the air travel at all; the crowded airports, the long security check lines, the smell of the jet fuel and the airline food! Add to that the recent terrorist attacks! It is just not worth it anymore.
One quick note about the normal kappa but low lambda: is that due to the lambda FLC suppression because of the Revlimid? There is some discussion about that under another topic and Multibilly has addressed that there. Of course, your oncologist has taken all that into account.
Great to read your responses, MMFeb16, 15 and Mike.
K_Shash
I am concerned about my kappa readings bouncing around 30 mg/dL. The last one was over 33, but the K/L ratio had dropped to 'within the normal range'. I assume that my oncologist is 'fine tuning' the Revlimid only maintenance dose to see if the 21 days x 10 mg and 7 days off helps reduce the kappa reading. He has not been too worried about this level (30 +/- of kappa) but may be the jump from 27.6 to 33.2 warranted a change. My oncologist is reluctant to add dex because of its long-term side effects. It is good to know that one's long-term health is still a major concern!
Hi Mike,
I am going through the same 'fine tuning' of the maintenance dose of Revlimid that you went through. Yes, I could not tolerate the 15 mg Revlimid for 21 days on and 7 days off after the dex was dropped completely from my drug regimen. I had the Revlimid rash on both my legs after 11 days of the daily 15 mg Revlimid. Therefore, the 15 mg on alternate days was tried. I hope the usual 10 mg Revlimid dose (21 days on and 7 days off) is more effective and that I can tolerate it. My oncologist, too, is essentially trying to put me on the highest Revlimid dose that I can tolerate.
GI problems: I am lucky and do not have any heart-related problems such as high BP or arrhythmia. However, I have had a severe acidosis for a long time. I cannot tolerate Motrin (ibuprofen) or aspirin and even the daily 81 mg coated aspirin seems to cause a bit of diarrhea. Nothing like that caused by the magnesium, though. I have not experienced any major cramps after dropping the daily 2 x 500 mg of the magnesium. I would try a smaller dose of magnesium if I do get the muscle cramps again.
On the positive side, I have been able to manage an active life and I do not feel the severe exhaustion after a short walk up a hill and I do not seem to need to lie down during the day. That was the case toward the end of my induction phase of the RVD treatment and during the dex days. I can manage long walks now and even a round of golf without riding a cart. I have not tried carrying a golf bag yet and instead used a 'push cart', only to avoid any shoulder pain. I really need the exercise (trying to settle into a 2 rounds of golf per week) to be able to sleep well and just have that overall 'feel good' sense.
I am glad you were traveling and had managed the travel to California and topped it with the hike up the Half Dome last year. I must be feeling healthier because I had a face mask but didn't even think of putting it on during the golf I played in the strong wind yesterday. However, I am almost paranoid about getting any infections and I have decided to avoid any air travel. I read the posts on the topic of the Alaska Airlines treatment of a myeloma patient and I have decided to travel only by a car, at least for now. I can manage to drive 3-hour stretches at a time and I can cover most of California. I had to travel a lot in my career (Europe, Asia and Central America and the numerous domestic trips) and I do not miss the air travel at all; the crowded airports, the long security check lines, the smell of the jet fuel and the airline food! Add to that the recent terrorist attacks! It is just not worth it anymore.
One quick note about the normal kappa but low lambda: is that due to the lambda FLC suppression because of the Revlimid? There is some discussion about that under another topic and Multibilly has addressed that there. Of course, your oncologist has taken all that into account.
Great to read your responses, MMFeb16, 15 and Mike.
K_Shash
-
K_Shash - Name: K_Shash
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: November 2014
- Age at diagnosis: 67
Re: Induction therapy to maintenance therapy - a transition
I just got my readings of
kappa = 33.1 (last reading 33.2), and
kappa / lambda = 1.49 (the last reading of 1.6).
My kappa / lambda shows a substantial improvement. When the recent flare up of allergic reaction (my EOS reading is at the high end of 6, from the past lower levels) is taken into account, both the kappa and lambda rising MAY indicate that almost 20% of the rise in both these parameters is due to these allergies (runny nose, too). Not too bad if I can manage to play at least a round of golf every week. It's hard to wear a face mask all the time, though. I try to avoid being exposed to high winds.
Also, I do not know if there was any impact of the timing of this blood test. I was in the middle of my 3 weeks on of the daily 10 mg Revlimid after switching from the 15 mg every alternate day. The next reading would have the effect, if any, of the 1-week off.
The new dosing may be more effective, if the tiredness I experienced toward the end of this 10 mg x 3-weeks on, is any indication. As always, I wonder (and my wife is always reminding me of it) if the tiredness and shoulder pains are caused by the Revlimid or just the normal effects of getting older. However, the week to week variations can only be explained by the changes in the Revlimid dosing. I am managing all my business activities, a weekly round of golf and some running around in the backyard with the grand kids and long walks, so no complaints!
All in all, my kappa and K/L levels are steady and the optimizing of the maintenance dosing seems to be in line with what mikeb has written about; his oncologist is trying to get him the maximum Revlimid dose that he can tolerate without the cardiovascular side effects. My oncologist's comment on the latest results was, as expected, stay with the current dosing for a couple of more cycles before we can draw any conclusions, i.e. no change for at least 2 more months.
Side effects:
I have had no diarrhea-like side effects, ever since I stopped the daily magnesium. I have experienced cramps only a couple of times since I stopped the magnesium. A little walking around (for the cramping feet) and stretching the fingers (only after playing a lot of video chess) cured those. However, I have almost an allergic reaction to black pepper (I have had to avoid jalapenos for a long time, too) and it has become so bad that I cannot tolerate roast beef in a sandwich or hamburgers (usually made with some spices). I get almost an immediate reaction to even a small amount of black pepper in soups or in burgers and have to find a bathroom within 30 minutes, well before the food is digested. I do not know if this is caused by the Revlimid. Please let me know if any of you are experiencing such dietary problems.
kappa = 33.1 (last reading 33.2), and
kappa / lambda = 1.49 (the last reading of 1.6).
My kappa / lambda shows a substantial improvement. When the recent flare up of allergic reaction (my EOS reading is at the high end of 6, from the past lower levels) is taken into account, both the kappa and lambda rising MAY indicate that almost 20% of the rise in both these parameters is due to these allergies (runny nose, too). Not too bad if I can manage to play at least a round of golf every week. It's hard to wear a face mask all the time, though. I try to avoid being exposed to high winds.
Also, I do not know if there was any impact of the timing of this blood test. I was in the middle of my 3 weeks on of the daily 10 mg Revlimid after switching from the 15 mg every alternate day. The next reading would have the effect, if any, of the 1-week off.
The new dosing may be more effective, if the tiredness I experienced toward the end of this 10 mg x 3-weeks on, is any indication. As always, I wonder (and my wife is always reminding me of it) if the tiredness and shoulder pains are caused by the Revlimid or just the normal effects of getting older. However, the week to week variations can only be explained by the changes in the Revlimid dosing. I am managing all my business activities, a weekly round of golf and some running around in the backyard with the grand kids and long walks, so no complaints!
All in all, my kappa and K/L levels are steady and the optimizing of the maintenance dosing seems to be in line with what mikeb has written about; his oncologist is trying to get him the maximum Revlimid dose that he can tolerate without the cardiovascular side effects. My oncologist's comment on the latest results was, as expected, stay with the current dosing for a couple of more cycles before we can draw any conclusions, i.e. no change for at least 2 more months.
Side effects:
I have had no diarrhea-like side effects, ever since I stopped the daily magnesium. I have experienced cramps only a couple of times since I stopped the magnesium. A little walking around (for the cramping feet) and stretching the fingers (only after playing a lot of video chess) cured those. However, I have almost an allergic reaction to black pepper (I have had to avoid jalapenos for a long time, too) and it has become so bad that I cannot tolerate roast beef in a sandwich or hamburgers (usually made with some spices). I get almost an immediate reaction to even a small amount of black pepper in soups or in burgers and have to find a bathroom within 30 minutes, well before the food is digested. I do not know if this is caused by the Revlimid. Please let me know if any of you are experiencing such dietary problems.
-
K_Shash - Name: K_Shash
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: November 2014
- Age at diagnosis: 67
Re: Induction therapy to maintenance therapy - a transition
Hi K_Shash,
Thanks for the recent update. Glad to hear that your kappa and lambda numbers are looking good. Also, glad to hear that the side effects of your current maintenance protocol are manageable.
Keep up the good work!
Mike
Thanks for the recent update. Glad to hear that your kappa and lambda numbers are looking good. Also, glad to hear that the side effects of your current maintenance protocol are manageable.
Keep up the good work!
Mike
-
mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: Induction therapy to maintenance therapy - a transition
I seem to be managing 'near normal life'. However, I just got the kappa and kappa / lambda readings this morning and they are rather disappointing. My kappa rose from 33.1 to 42.6 and the kappa / lambda ratio rose to 1.7 from 1.49.
The 'trend' is of major concern: my kappa has risen from a steady 12.5 / 12.6 level to 42.6 over the last 6 or 7 months; ever since the weekly 20 mg dex was dropped completely and the Revlimid dropped to 10 mg from 15 mg because I could not tolerate the original dose in the absence of the dex. I had both the readings stable; kappa at around 13 and and kappa / lambda ratio 1.1 +/- levels for 3 months after stopping the Velcade shots.
Therefore, I have asked my oncologist to consider adding back at least 8 or 12 mg of weekly dex and going back to 15 mg Revlimid (3 weeks daily and 1 week off), assuming I can tolerate the higher original dose of Revlimid with the supplemental dex. The slight improvement in my readings last month would be the cause of an overall higher intake of Revlimid during the overlap of the 15 mg alternate day dosing and the 10 mg daily dosing for 3 weeks before the 1-week break.
I opted for NO autologous stem cell transplant (ASCT) and I want to make sure my kappa and kappa / lambda readings remain in the normal band. I am not sure if these high readings (kappa well above the 19.3), 8 months after starting the 'tapering down' of the dosing, are alarming. I would appreciate knowing when other oncologist(s) started Revlimid (for those who had an ASCT) or increased the maintenance levels of the Revlimid (with or without dex).
Actually, I was guessing/hoping that my kappa and kappa / lambda would be lower than the last 33.1 and 1.49, respectively. I have been feeling a little more tired last week and I thought the daily 10 mg Revlimid was working better and causing me to be more tired. However, the tests show that that was not the case.
The 'trend' is of major concern: my kappa has risen from a steady 12.5 / 12.6 level to 42.6 over the last 6 or 7 months; ever since the weekly 20 mg dex was dropped completely and the Revlimid dropped to 10 mg from 15 mg because I could not tolerate the original dose in the absence of the dex. I had both the readings stable; kappa at around 13 and and kappa / lambda ratio 1.1 +/- levels for 3 months after stopping the Velcade shots.
Therefore, I have asked my oncologist to consider adding back at least 8 or 12 mg of weekly dex and going back to 15 mg Revlimid (3 weeks daily and 1 week off), assuming I can tolerate the higher original dose of Revlimid with the supplemental dex. The slight improvement in my readings last month would be the cause of an overall higher intake of Revlimid during the overlap of the 15 mg alternate day dosing and the 10 mg daily dosing for 3 weeks before the 1-week break.
I opted for NO autologous stem cell transplant (ASCT) and I want to make sure my kappa and kappa / lambda readings remain in the normal band. I am not sure if these high readings (kappa well above the 19.3), 8 months after starting the 'tapering down' of the dosing, are alarming. I would appreciate knowing when other oncologist(s) started Revlimid (for those who had an ASCT) or increased the maintenance levels of the Revlimid (with or without dex).
Actually, I was guessing/hoping that my kappa and kappa / lambda would be lower than the last 33.1 and 1.49, respectively. I have been feeling a little more tired last week and I thought the daily 10 mg Revlimid was working better and causing me to be more tired. However, the tests show that that was not the case.
-
K_Shash - Name: K_Shash
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: November 2014
- Age at diagnosis: 67
Re: Induction therapy to maintenance therapy - a transition
Dear K_Shash:
Based on my experience and my hematologists' comment, I would not worry too much about kappa free light chain fluctuation in the range you have encountered. However, your hematologist will give you ultimate advice.
Dear K_Shash and Mikeb:
After the ninth cycle (25 mg Revlimid, 16 mg dex), my kappa free light chain level was 5.63 mg/dl, K/L ratio 2.47 and my M-spike 0.7 g/dl. After the eleventh cycle, it was kappa FLC 6.94 mg/dl, K/L ratio 1.84 and my M-spike 0.36 g/dl. I continued twelfth cycle to bring the M-spike to zero. However, readings are: kappa FLC 4.90 mg/dl, K/L ratio 1.70 and M-spike 0.34 g/dl.
Side effects during the twelfth cycle were extreme. One additional being added was foggy thinking process.
I am off Revlimid plus dex as I am traveling and away from my main hematologist. I am feeling much better and my foggiest of brain or thinking process has completely disappeared. Other side effects come and go such as bloating, no appetite, lack of sleep etc. as if all side effects visiting and saying good bye - withdrawal symptoms.
My hematologist in my traveling location suggests I take Velcade for four months to bring the M-spike to zero. However, there is no guarantee it will happen. My main hematologist will suggest an autologous stem cell transplant (ASCT). I do not want to go for ASCT.
My current thinking is to abstain any chemo as long as my M-spike and kappa free light chains are stable. If it shows rising, I will take Revlimid plus dex in reduced dose. Do you have any comments or suggestions?
Based on my experience and my hematologists' comment, I would not worry too much about kappa free light chain fluctuation in the range you have encountered. However, your hematologist will give you ultimate advice.
Dear K_Shash and Mikeb:
After the ninth cycle (25 mg Revlimid, 16 mg dex), my kappa free light chain level was 5.63 mg/dl, K/L ratio 2.47 and my M-spike 0.7 g/dl. After the eleventh cycle, it was kappa FLC 6.94 mg/dl, K/L ratio 1.84 and my M-spike 0.36 g/dl. I continued twelfth cycle to bring the M-spike to zero. However, readings are: kappa FLC 4.90 mg/dl, K/L ratio 1.70 and M-spike 0.34 g/dl.
Side effects during the twelfth cycle were extreme. One additional being added was foggy thinking process.
I am off Revlimid plus dex as I am traveling and away from my main hematologist. I am feeling much better and my foggiest of brain or thinking process has completely disappeared. Other side effects come and go such as bloating, no appetite, lack of sleep etc. as if all side effects visiting and saying good bye - withdrawal symptoms.
My hematologist in my traveling location suggests I take Velcade for four months to bring the M-spike to zero. However, there is no guarantee it will happen. My main hematologist will suggest an autologous stem cell transplant (ASCT). I do not want to go for ASCT.
My current thinking is to abstain any chemo as long as my M-spike and kappa free light chains are stable. If it shows rising, I will take Revlimid plus dex in reduced dose. Do you have any comments or suggestions?
-
MMFeb16,15 - Who do you know with myeloma?: Self
- When were you/they diagnosed?: February 16, 2015
- Age at diagnosis: 66
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