[DexMed]

Maintenance or not before delayed ASCT?

by DexMed on Tue May 19, 2015 2:26 am

I am 67. I finished CyBorD [cyclophosphamide, Velcade, dexamethasone] induction, about to harvest stem cells in a week. Induction was stopped after 3 cycles instead of original planned 4 cycles due to near complete remission (M protein zero and bone marrow plasma cell percentage reduction from 33 to less than 1) and start of mild peripheral neuropathy.

If I need to delay my autologous stem cell transplant (ASCT) by 6 to 10 months, do I need to go on maintenance with 10 mg Revlimid as currently recommended? Or go on NO maintenance until progression and do ASCT soon after?

If I choose not to do maintenance, any idea how long the current remission May last? Have any others tried to go drug-free just after induction?

Last edited by DexMed on Wed May 20, 2015 11:27 am, edited 1 time in total.

[Multibilly]

Re: Maintenance or not before delayed ASCT

by Multibilly on Tue May 19, 2015 8:07 am

GV,

That's an interesting question. Namely, does one go on to maintenance prior to doing a transplant, when you know it is only a few months down the road and there many not necessarily be the usual situation of disease progression that would signal the need for a delayed transplant (or reinstating drug treatment)?

Are you worried about the side effects of 10mg Revlimid for 6+ months or is there another reason you are considering not doing maintenance?

I don't think anybody can predict how long your current "remission" will last. It could be months or it could be years. Every multiple myeloma patient is a snow flake.

[DexMed]

Re: Maintenance or not before delayed ASCT?

by DexMed on Tue May 19, 2015 8:46 am

Thanks, MultibiIlly, for your quick response, which helped me clarify my reasons.

During induction, the side effects were quite challenging. Also, Velcade and dex caused mild neuropathy. I have had diabetes for a long time, was controlled until recently.

I do not qualify for financial assistance, yet. On Medicare, the first month of Revlimid will put me past the donut hole, so $4700 plus 5 percent of $13000 per month ($650). About $9k in current calendar year. Another myeloma patient I know had to stop 5 mg Revlimid maintenance after few months due to very severe rash.

Perhaps there is some other maintenance option besides Velcade or Revlimid? Kyprolis is an injection, so Medicare covers it. Low-dose dex? Going drug free? Even if I relapse and follow with a delayed ASCT, the outcome may not be much different.