Hello all,
My mother diagnosed with multiple myeloma in May 2014 with Stage III.
Initial treatment completed with Velcade (bortezomib0 / dexamethasone for 7 cycles of chemo. After chemos her disease was pretty much under control.
Then we had gone for bone marrow transplantation in January 2015 with high-dose chemo with melphalan. Transplant was successful with little side effects.
She was doing well until October 2015. Since then her M-spike, IgG kappa, and plasma cells are increasing.
Kappa Light Chain Free Serum * (Immunoturbidimetry) 232.3 H mg/L
M-spike 1.22 G/DL
Since October 2015 she is on maintenance with lenalidomide with 10 mg oral tablet, but still her levels are increasing.
Can you please suggest me what are all other drugs to be used? (For sure, her doctor decision final based on her condition.)
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Re: M-spike, kappa increasing - treatment options?
Welcome to the forum. I'm sorry to hear that your mother's disease seems to be relapsing.
Treatment options for multiple myeloma vary from one country to the other. In what country does your mother live?
Treatment options for multiple myeloma vary from one country to the other. In what country does your mother live?
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Jonah
Re: M-spike, kappa increasing - treatment options?
She lives in India.
Her levels are increased a lot.. Current M-spike is 4.69 with IgG kappa of 3000.
Her levels are increased a lot.. Current M-spike is 4.69 with IgG kappa of 3000.
Re: M-spike, kappa increasing - treatment options?
Hello anyerram,
The first thing your mother's doctors will probably consider is increasing the dose of lenalidomide (Revlimid) that she is receiving, and also adding dexamethasone to the treatment regimen. They could also get creative and Biaxin (clarithromycin) to the Revlimid and dexamethasone regimen; Biaxin often deepens responses to the combination of lenalidomide and dex.
If your mother were in the U.S., her doctors would probably consider adding either Kyprolis (carfilzomib) or Empliciti (elotuzumab) and dexamethasone to her lenalidomide. However, I suspect it will be difficult and/or expensive to get access to either Kyprolis or Empliciti in India.
If the Revlimid regimens do not work, then it might make sense to see if your mother responds again to Velcade in combination with cyclophosphamide and dexamethasone (VCD / CyBorD), or to try cyclophosphamide, thalidomide, and dexamethasone (CTD).
Her doctors could even try Velcade together with the CTD regimen (VCTD)
At some point, her doctors also may consider VAD (vincristine, doxorubicin, dexamethasone), simply because all the drugs in the regimen are older, easily available, and cheap.
This will probably be an easier combination to try instead of regimens based on either Pomalyst (pomalidomide, Imnovid) or Darzalex (daratumumab), which – like Kyprolis and Empliciti – are probably not easily accessible in India.
Finally, you may want to remind her doctors to consider bendamustine (Treanda) in combination with prednisone and perhaps Velcade. I don't know, though, whether bendamustine is readily available and cheap in India.
Good luck!
The first thing your mother's doctors will probably consider is increasing the dose of lenalidomide (Revlimid) that she is receiving, and also adding dexamethasone to the treatment regimen. They could also get creative and Biaxin (clarithromycin) to the Revlimid and dexamethasone regimen; Biaxin often deepens responses to the combination of lenalidomide and dex.
If your mother were in the U.S., her doctors would probably consider adding either Kyprolis (carfilzomib) or Empliciti (elotuzumab) and dexamethasone to her lenalidomide. However, I suspect it will be difficult and/or expensive to get access to either Kyprolis or Empliciti in India.
If the Revlimid regimens do not work, then it might make sense to see if your mother responds again to Velcade in combination with cyclophosphamide and dexamethasone (VCD / CyBorD), or to try cyclophosphamide, thalidomide, and dexamethasone (CTD).
Her doctors could even try Velcade together with the CTD regimen (VCTD)
At some point, her doctors also may consider VAD (vincristine, doxorubicin, dexamethasone), simply because all the drugs in the regimen are older, easily available, and cheap.
This will probably be an easier combination to try instead of regimens based on either Pomalyst (pomalidomide, Imnovid) or Darzalex (daratumumab), which – like Kyprolis and Empliciti – are probably not easily accessible in India.
Finally, you may want to remind her doctors to consider bendamustine (Treanda) in combination with prednisone and perhaps Velcade. I don't know, though, whether bendamustine is readily available and cheap in India.
Good luck!
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Jonah
Re: M-spike, kappa increasing - treatment options?
It is not very common to relapse so soon after the stem cell transplant. There is a newer drug Darzalex (daratumumab) which has great results with RD.
Curious to know her age at diagnosis? Does she have any other health issues – diabetes, etc.? Most oncologists consider an overall health situation before proceeding with a specific regimen.
Wish her well.
Curious to know her age at diagnosis? Does she have any other health issues – diabetes, etc.? Most oncologists consider an overall health situation before proceeding with a specific regimen.
Wish her well.
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DexMed - Name: GV
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: May 2010 Smoldering. Symptomatic 9/2014
- Age at diagnosis: 62
Re: M-spike, kappa increasing - treatment options?
Hello Jonah and Dex Med,
Yes, it is very unfortunate that her disease came back very quickly.
As you said, pomalidomide, Kyprolis and Empliciti drugs are not available in India and if we want import from other countries it is going to be very costly.
Her current age is 58 and she was diagnosed at the age of 56.
As of now, she is having infection in blood, treatment is going on with antibiotics to reduce the infection in blood. The doctor has suggested that, once the infection is free, he will try to give bortezomib (Velcade) to reduce the disease.
But her hemoglobin and platelets are decreasing so fast, this is very tense for us.
She has been diabetic for 12 years, but her levels are pretty much under control even now also, Even her kidney function is very good.
Just wanted to understand, with above complications, can M-spike and kappa free light chain level be controlled to prolong her life?
Requesting only suggestion, All the possible treatment options will be discussed with doctor.
Yes, it is very unfortunate that her disease came back very quickly.
As you said, pomalidomide, Kyprolis and Empliciti drugs are not available in India and if we want import from other countries it is going to be very costly.
Her current age is 58 and she was diagnosed at the age of 56.
As of now, she is having infection in blood, treatment is going on with antibiotics to reduce the infection in blood. The doctor has suggested that, once the infection is free, he will try to give bortezomib (Velcade) to reduce the disease.
But her hemoglobin and platelets are decreasing so fast, this is very tense for us.
She has been diabetic for 12 years, but her levels are pretty much under control even now also, Even her kidney function is very good.
Just wanted to understand, with above complications, can M-spike and kappa free light chain level be controlled to prolong her life?
Requesting only suggestion, All the possible treatment options will be discussed with doctor.
6 posts
• Page 1 of 1
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