My question is for Dr. Hofmeister. First, thanks for posting on this forum. Great opportunity for discussion. I am relatively newly diagnosed. I was diagnosed because I have acute renal failure. (tho I thought it was the flu)......I have just completed my induction cycles of Vel/Dex, with good response from the numbers. I have no skeletal involvement, and 20% on initial BM, low risk on genetics, and no response from my kidneys. My oncologist has suggested one year of maintenance ( Vel ) and that I am not a great candidate for SCT due to my renal failure and dialysis situation.
1. Is this true? Some of my research suggested that SCT might be a way to rescue my kidneys?
2. Any other suggestions on how to get my kidneys back?
I would trade CR, for VGPR for my kidneys...I am a nurse, and I want to be working full time. And I have two children 8 and 5. Dialysis SUCKS!!!
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pegmac - Name: Peg O'Dean
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: Jan. 2010
- Age at diagnosis: 46
Re: Kidney failure: transplant or novel drug
Great questions all of them.
Are you on dialysis? It sounds like yes. If true, your risk of side effects from autologous transplant are therefore higher -- but that doesn't mean you aren't a good candidate. If you are in complete remission (negative serum free light chains, negative urine immunofixation, negative serum immunofixation), then I can see holding off transplant until the 5 year old is older.
Otherwise, the eligibility for autologous transplant includes good performance status, good liver/cardiac/lung status, and kidneys are "optional". In other words, autologous transplant should be dose-reduced (melphalan 140 mg / m2 rather than the standard 200 mg/m2), but really no other modifications to the standard autologous) transplant procedure for patients on dialysis.
1. So the answer to question #1 is YES, but with Velcade and Revlimid (i.e. more effective induction regimens), the chances that your kidneys will improve with autologous transplant is minimal as long as you have responded well to Velcade/dexamethasone. Key thing is that you need to get into remission to make sure your kidneys have every chance of getting better.
2. No except to avoid medications that can damage the kidneys and, if you are able to get off dialysis, VERY close observation of you myeloma in follow-up to make sure that no future damage occurs.
Are you on dialysis? It sounds like yes. If true, your risk of side effects from autologous transplant are therefore higher -- but that doesn't mean you aren't a good candidate. If you are in complete remission (negative serum free light chains, negative urine immunofixation, negative serum immunofixation), then I can see holding off transplant until the 5 year old is older.
Otherwise, the eligibility for autologous transplant includes good performance status, good liver/cardiac/lung status, and kidneys are "optional". In other words, autologous transplant should be dose-reduced (melphalan 140 mg / m2 rather than the standard 200 mg/m2), but really no other modifications to the standard autologous) transplant procedure for patients on dialysis.
1. So the answer to question #1 is YES, but with Velcade and Revlimid (i.e. more effective induction regimens), the chances that your kidneys will improve with autologous transplant is minimal as long as you have responded well to Velcade/dexamethasone. Key thing is that you need to get into remission to make sure your kidneys have every chance of getting better.
2. No except to avoid medications that can damage the kidneys and, if you are able to get off dialysis, VERY close observation of you myeloma in follow-up to make sure that no future damage occurs.
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Dr. Craig Hofmeister - Name: Craig C. Hofmeister, M.D.
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