Has anyone been treated for latent TB (tuberculosis) at the same time as having Velcade? My specialist is proposing this and I'm concerned about the effects both treatments might have on my liver.
I was diagnosed in September with multiple myeloma and there is much for me to learn.
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Missy B - Name: Missy B
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: September 2013
- Age at diagnosis: 59
Re: Latent tuberculosis (TB) treatment while on Velcade?
Hello,
Is there any reason your doctor may think that you are harboring latent TB?
I found this article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625000/
Is there any reason your doctor may think that you are harboring latent TB?
I found this article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625000/
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dnalex - Name: Alex N.
- Who do you know with myeloma?: mother
- When were you/they diagnosed?: 2007
- Age at diagnosis: 56
Re: Latent tuberculosis (TB) treatment while on Velcade?
Hi Missy,
My guess is that since TB is systemic, your doc doesn't want to risk it becoming more active. Similar to the reason many people on Velcade take antiviral drugs to avoid an outbreak of Shingles.
Lyn
My guess is that since TB is systemic, your doc doesn't want to risk it becoming more active. Similar to the reason many people on Velcade take antiviral drugs to avoid an outbreak of Shingles.
Lyn
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Christa's Mom - Name: Christa's Mom
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: September, 2010
- Age at diagnosis: 53
Re: Latent tuberculosis (TB) treatment while on Velcade?
Thank you for your responses - It's a great relief to have this forum to turn to for input, information, reassurance etc etc.
As a child I reacted positively to the Mantoux test for TB and subsequent x-rays showed scarring on my lungs - though I was never diagnosed as having active TB at that time (or ever). i have also been involved with aid work for the last 17 years in Africa and regularly come into contact with people who have active TB.
I understand the importance of treating any possible latent TB in my system so that when I begin chemo there is no chance of it becoming active. But my concern is that my specialist now seems very keen to begin Velcade as soon as possible, which would mean I would be taking Isoniazid at the same time as the chemo. I have read that not only would that reduce the efficacy of the Velcade, but I'm also concerned about the effects on my liver.
Thank you for the link to the article. I appreciate your thoughts.
As a child I reacted positively to the Mantoux test for TB and subsequent x-rays showed scarring on my lungs - though I was never diagnosed as having active TB at that time (or ever). i have also been involved with aid work for the last 17 years in Africa and regularly come into contact with people who have active TB.
I understand the importance of treating any possible latent TB in my system so that when I begin chemo there is no chance of it becoming active. But my concern is that my specialist now seems very keen to begin Velcade as soon as possible, which would mean I would be taking Isoniazid at the same time as the chemo. I have read that not only would that reduce the efficacy of the Velcade, but I'm also concerned about the effects on my liver.
Thank you for the link to the article. I appreciate your thoughts.
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Missy B - Name: Missy B
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: September 2013
- Age at diagnosis: 59
Re: Latent tuberculosis (TB) treatment while on Velcade?
Hello Missy B.,
I have no idea as to why certain doctors would choose to pre-emptively treat for latent TB, while others do not choose to do so.
Take for example my mom's case. She was positive for the tuberculin skin test when we immigrated to the United States in the mid 1980s, and was put on INH for six months. I don't believe that at the time, X-rays, or any other tests gave indications of TB, other than the positive skin reactivity, which could very well have been from the BCG vaccination she received as a child.
Fast forward to her myeloma treatment. While my mom has to take acyclovir daily during the entire treatment time (and even now), treatment for latent TB never entered into the picture, either with her local doctor or the doctor at the myeloma treatment center that she goes to. (Both docs are myeloma specialists.)
Your concerns are very valid, and perhaps it would be good to ask him whether it's absolutely necessary. Alternately, you could go through with the INH + myeloma treatment to see if you: 1) can tolerate the regimen well, and 2) respond well to the myeloma drugs, despite having INH on board.
I have no idea as to why certain doctors would choose to pre-emptively treat for latent TB, while others do not choose to do so.
Take for example my mom's case. She was positive for the tuberculin skin test when we immigrated to the United States in the mid 1980s, and was put on INH for six months. I don't believe that at the time, X-rays, or any other tests gave indications of TB, other than the positive skin reactivity, which could very well have been from the BCG vaccination she received as a child.
Fast forward to her myeloma treatment. While my mom has to take acyclovir daily during the entire treatment time (and even now), treatment for latent TB never entered into the picture, either with her local doctor or the doctor at the myeloma treatment center that she goes to. (Both docs are myeloma specialists.)
Your concerns are very valid, and perhaps it would be good to ask him whether it's absolutely necessary. Alternately, you could go through with the INH + myeloma treatment to see if you: 1) can tolerate the regimen well, and 2) respond well to the myeloma drugs, despite having INH on board.
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dnalex - Name: Alex N.
- Who do you know with myeloma?: mother
- When were you/they diagnosed?: 2007
- Age at diagnosis: 56
Re: Latent tuberculosis (TB) treatment while on Velcade?
Thanks Alex, I certainly feel I have plenty of questions to ask now before I agree to proceed with both treatments. It's such a relief to be able to 'talk' things through with someone else.
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Missy B - Name: Missy B
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: September 2013
- Age at diagnosis: 59
Re: Latent tuberculosis (TB) treatment while on Velcade?
Hello Missy,
It is true that Velcade can weaken a patients immunity and perhaps could reactivate TB. Just as important though is that virtually all patients with myeloma receive steroids as part of their treatment. Steroids are well known to affect a patients immunity and the large doses of steroids used in myeloma could certainly be of concern if you have a positive TB test.
It is true that Velcade can weaken a patients immunity and perhaps could reactivate TB. Just as important though is that virtually all patients with myeloma receive steroids as part of their treatment. Steroids are well known to affect a patients immunity and the large doses of steroids used in myeloma could certainly be of concern if you have a positive TB test.
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Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
Re: Latent tuberculosis (TB) treatment while on Velcade?
Thanks very much for your response Dr Libby. I accept the importance of having treatment for latent TB as soon as possible.
Will be safe for me to take Isoniazid to treat the latent TB at the same time as receiving Velcade? (I'm newly diagnosed and I live in a small city in New Zealand, so I don't have many options for second opinions etc).
Will be safe for me to take Isoniazid to treat the latent TB at the same time as receiving Velcade? (I'm newly diagnosed and I live in a small city in New Zealand, so I don't have many options for second opinions etc).
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Missy B - Name: Missy B
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: September 2013
- Age at diagnosis: 59
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