April Nelson's superb Beacon column today about warfarin and her platelet challenges prompted me to write this message.
I was told yesterday by my local onc doc that, after 3 plus fairly uneventful years on Revlimid and a stem cell transplant, my platelets are dropping. Down to 76k (low normal is about twice that). So he is recommending going to two weeks on Revlimid 10's and two weeks off, rather than the usual 21 of 28 days on. I'm checking this idea with my Mayo myeloma doc. I've not heard of people on two weeks per month, but it may be fine? Thoughts? I have been on Revlimid three and a half years except for the 100 or so days after the transplant, which I had a Mayo Rochester in February 2014.
My other choice is to discontinue Xarelto 20's daily, but that doesn't seem to be smart because I had a DVT and a TIA both early in my treatment (TIA before the transplant and DVT after. Fortunately, neither event had any lasting challenges... )
A third alternative is to stay on the current Revlimid/Xarelto dosages, but the local onc feels some intervention to boost platelet is needed.
What do you think?
This is a bit tough emotionally - it is a small "hiccup", perhaps, but the first I've had since my successful transplant and remission. I'm still in remission, thankfully. My SPEP shows no monoclonal protein, and has been that way since March of 2015 (it took a while to realize the full effect of the 2014 transplant)
Thanks to all of you out there. Couldn't do it without you!!
Wesley
Forums
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wesley - Who do you know with myeloma?: me
- When were you/they diagnosed?: July, 2013
- Age at diagnosis: 60
Re: Low platelet count & 2-week Revlimid cycle
Hi Wesley,
Go figure. I guess I'm surprised that one can develop thrombocytopenia after such a long time of being on the same drug regimen with no side effects. I wonder what happens in one's body to cause a platelet drop after three years with no issues and still being in remission?
Sounds like double-checking with your Mayo doc is a wise move. Let us know what you find out.
Go figure. I guess I'm surprised that one can develop thrombocytopenia after such a long time of being on the same drug regimen with no side effects. I wonder what happens in one's body to cause a platelet drop after three years with no issues and still being in remission?
Sounds like double-checking with your Mayo doc is a wise move. Let us know what you find out.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Low platelet count & 2-week Revlimid cycle
Hi Wesley,
Sorry to hear about the low platelet count. I did see a paper that may be discussing what you describe.
"We report four cases of ITP developing during LEN therapy with the characteristics of ITP. None of these patients had a history of previous autoimmune events, the decline of platelet count was rapid and other causes of thrombocytopenia were excluded or unlikely in all the cases. Furthermore diagnosis was supported by consistent bone marrow evaluation in two cases. Considering the temporal association in these four cases, the ITP mechanism may be related to the immunomodulation and T‐cell activation caused by LEN.
Even if further other studies are needed, it seems reasonable to consider a possible association between LEN and autoimmune phenomena, in particular ITP."
Source:
Pompa, A, et al, "Four Cases of Lenalidomide-Associated Immune Thrombocytopenia," Blood 2016 (full text of article)
Lenalidomide inhibits angiogenesis. These are the side effects typically associated with drugs that inhibit angiogenesis.
"Initially, it was thought that angiogenesis inhibitors would have mild side effects, but more recent studies have revealed the potential for complications that reflect the importance of angiogenesis in many normal body processes, such as wound healing, heart and kidney function, fetal development, and reproduction. Side effects of treatment with angiogenesis inhibitors can include problems with bleeding, clots in the arteries (with resultant stroke or heart attack), hypertension, and protein in the urine (3–5). Gastrointestinal perforation and fistulas also appear to be rare side effects of some angiogenesis inhibitors. Animal studies have revealed the potential for birth defects, although there is no clinical evidence for such effects in humans.
It is likely that some of the possible complications of angiogenesis inhibitor therapy remain unknown. As more patients are treated with these agents, doctors will learn more about possible rare side effects." (Source)
Good luck moving forward and it would be informative to hear what your specialist says about this.
Mark
Sorry to hear about the low platelet count. I did see a paper that may be discussing what you describe.
"We report four cases of ITP developing during LEN therapy with the characteristics of ITP. None of these patients had a history of previous autoimmune events, the decline of platelet count was rapid and other causes of thrombocytopenia were excluded or unlikely in all the cases. Furthermore diagnosis was supported by consistent bone marrow evaluation in two cases. Considering the temporal association in these four cases, the ITP mechanism may be related to the immunomodulation and T‐cell activation caused by LEN.
Even if further other studies are needed, it seems reasonable to consider a possible association between LEN and autoimmune phenomena, in particular ITP."
Source:
Pompa, A, et al, "Four Cases of Lenalidomide-Associated Immune Thrombocytopenia," Blood 2016 (full text of article)
Lenalidomide inhibits angiogenesis. These are the side effects typically associated with drugs that inhibit angiogenesis.
"Initially, it was thought that angiogenesis inhibitors would have mild side effects, but more recent studies have revealed the potential for complications that reflect the importance of angiogenesis in many normal body processes, such as wound healing, heart and kidney function, fetal development, and reproduction. Side effects of treatment with angiogenesis inhibitors can include problems with bleeding, clots in the arteries (with resultant stroke or heart attack), hypertension, and protein in the urine (3–5). Gastrointestinal perforation and fistulas also appear to be rare side effects of some angiogenesis inhibitors. Animal studies have revealed the potential for birth defects, although there is no clinical evidence for such effects in humans.
It is likely that some of the possible complications of angiogenesis inhibitor therapy remain unknown. As more patients are treated with these agents, doctors will learn more about possible rare side effects." (Source)
Good luck moving forward and it would be informative to hear what your specialist says about this.
Mark
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Mark11
3 posts
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