[Vijayabharathi]

M Spike 0 to 1.3

by Vijayabharathi on Wed Aug 22, 2012 4:02 am

Hi

My mother was diagnosed with multiple myeloma during May 2011, After 6 cycles of Revlimid.. Her M Protein become Nil.. She became ineligible for HSCT after not able to collect enough stem cells.. she was advised with conventional theraphy.. But still not able to take conventional theraphy for first 4 months from remission due to continuous fall of WBC for maintenance therapy.. We started again maintainence theraphy of Revlimid 5 mg from may 2012.. WBC count was better!!.. But Sad news today is we found m-spike of 1,3..

How serious is this change? Please tell me!!..

We found serum creatinine also slightly elevated of 1.3..

Regards
Vijayabharathi C

[Vijayabharathi]

Re: M Spike 0 to 1.3

by Vijayabharathi on Wed Aug 22, 2012 7:56 am

Today again blood test we found Creatinine - 0.7 quite normal.. but calcium increased from 7.5 a month back to 11.4.. She was taking 2 tablets for calcium daily as she was having less calcium before..

[Dr. Peter Voorhees]

Re: M Spike 0 to 1.3

by Dr. Peter Voorhees on Thu Aug 23, 2012 9:24 pm

A 1.3 g/dL increase in the M spike is a notable change, although the clinical significance of this rise varies from one patient to the next. In your mother's case, with the elevated calcium, it would seem that the myeloma is knocking on the door. I would strongly suggest changing therapy. A velcade-based approach would be a good consideration.

Best of luck!

Pete V.

[Vijayabharathi_c]

Re: M Spike 0 to 1.3

by Vijayabharathi_c on Fri Aug 24, 2012 10:48 am

Dear Sir,

Many thanks for the suggestions!! Yes today we met some doctors and doctors panel decided for Bortezomib treatment from tomorrow. After she get a response,doctors will re-evaluate for transplant option if possible.

She was taking just 5mg Revlimid maintainence theraphy, that too properly from May 2012. For nearly 4 months, she didnt take the Revlimid properly due to myelosuppression. I have posted same in forum also

https://myelomabeacon.org/forum/sideeffect-of-revlimid-t841.html
My question is
Is this mean the resistance for Revlimid started?
Even if the Revlimid is increased to 25mg, at this stage no use ?

This M-Spike of 1.3mg/DL is from July 22nd SPEP report.. Dont know how much elevated now!! But my mom is still better without any big symptoms.Calcium elevation too happened this week

Regards
Vijayabharathi C

[Vijayabharathi_c]

Re: M Spike 0 to 1.3

by Vijayabharathi_c on Sat Aug 25, 2012 11:25 am

Today doctors started the Bortezomib(Velcade) based therapy to my mother for her current condition.
Latest BMA shows 30% myeloma cells.. finally myeloma relapsed within 8 months even after CR for Revlimid 25mg 6 cycles.. very unfortunate

As instructed by doctors

Weekly Bortezomib schedule

Inj Bortezomib Subcutanous 2mg weekly once on

D1: 25/08/2012 (Today)
D2: 01/09/2012
D3: 08/09/2012
D4: 15/09/2012

Protocol to be repeated every 5 weeks(Next cycles will start on 29/09/2012)
Patient will be due for next Zometa on 21/09/2012

Check Hemogram including platelets before each dose and ensure that they are normal.
Patient has to take the following medicines

Tab Acivir 400mg BD daily continuously till the time she is on Bortezomib
Tab Shelcal 500mg BD
Tab Dexamethasone 4mg (3-0-2) weekly once
Tab Pantoacid 40mg OD once a week on the day of dexamethasone

Blood Sugars need to be monitored when dexamethasone is given

[Dr. Peter Voorhees]

Re: M Spike 0 to 1.3

by Dr. Peter Voorhees on Sat Aug 25, 2012 1:45 pm

Disease progression on 5 mg of Revlimid does not indicate resistance to this agent. A response could certainly be re-captured with a higher dose. However, if your Mom was not tolerating 5 mg due to low blood counts, a higher dose will likely not be well tolerated, with even more significant depression of the blood counts.

Good luck on the new regimen!

Pete V.