This week I will begin a new treatment regimen of 40 mg of melphalan daily for 4 days and 20 mg of dexamethasone weekly. I am fully aware of what to expect from the dex, as I have taken it before. I am in the dark so far as the melphalan is concerned.
What can I expect from the melphalan when it's given orally, outside the transplant environment? I am expecting some nausea and gastrointestinal problems, but I don't know how bad they will get. What other side effects can be expected?
Charlie (grouchy German)
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Grizlump - Name: Charlie
- Who do you know with myeloma?: me
- When were you/they diagnosed?: June 2014
- Age at diagnosis: 67
Re: Melphalan and dexamethasone treatment: what to expect?
Hi Charlie,
You don't often see the melphalan-dexamethasone regimen being used to treat multiple myeloma. I think this is due to the results of a clinical trial comparing melphalan-dex to several other treatment regimens. The results of the trial were published in the mid 2000s. The results showed that response rates were quite good with melphalan-dex, but the higher response rates didn't translate into noticeably better survival outcomes, and the regimen had a lot of side effects compared, for example, with melphalan plus prednisone.
However, the dexamethasone dosing used in the study was intense by current standards. This almost certainly caused the side effects to be more frequent and more significant than you would see with a melphalan-dex regimen such as yours.
The main issue with melphalan, as with many myeloma drugs, is that it can depress blood counts. This makes patients more susceptible to infection. In the study I mentioned, combining melphalan with dex seemed to increase the risk of lung and blood infections, as well as blood clots and even perforated diverticulums, compared to melphalan and prednisone.
You can view the article about the study here:
"Dexamethasone-based regimens versus melphalan-prednisone for elderly multiple myeloma patients ineligible for high-dose therapy"
http://www.bloodjournal.org/content/107/4/1292.long
Table 5 in the article summarizes the observed non-hematologic side effects of the four treatment regimens tested in the study.
Let me wrap this up by saying that, despite what I wrote above, I think it's great that your doctor is experimenting with something like melphalan-dexamethasone to treat your myeloma. He/she seems to be making certain that all your myeloma treatment options are exhausted to the fullest extent possible, which is important to extending survival as much as possible.
Best of luck to you, and let us know how you do on this new regimen.
You don't often see the melphalan-dexamethasone regimen being used to treat multiple myeloma. I think this is due to the results of a clinical trial comparing melphalan-dex to several other treatment regimens. The results of the trial were published in the mid 2000s. The results showed that response rates were quite good with melphalan-dex, but the higher response rates didn't translate into noticeably better survival outcomes, and the regimen had a lot of side effects compared, for example, with melphalan plus prednisone.
However, the dexamethasone dosing used in the study was intense by current standards. This almost certainly caused the side effects to be more frequent and more significant than you would see with a melphalan-dex regimen such as yours.
The main issue with melphalan, as with many myeloma drugs, is that it can depress blood counts. This makes patients more susceptible to infection. In the study I mentioned, combining melphalan with dex seemed to increase the risk of lung and blood infections, as well as blood clots and even perforated diverticulums, compared to melphalan and prednisone.
You can view the article about the study here:
"Dexamethasone-based regimens versus melphalan-prednisone for elderly multiple myeloma patients ineligible for high-dose therapy"
http://www.bloodjournal.org/content/107/4/1292.long
Table 5 in the article summarizes the observed non-hematologic side effects of the four treatment regimens tested in the study.
Let me wrap this up by saying that, despite what I wrote above, I think it's great that your doctor is experimenting with something like melphalan-dexamethasone to treat your myeloma. He/she seems to be making certain that all your myeloma treatment options are exhausted to the fullest extent possible, which is important to extending survival as much as possible.
Best of luck to you, and let us know how you do on this new regimen.
Re: Melphalan and dexamethasone treatment: what to expect?
Cheryl G,
Thanks for your informative response to my inquiry about melphalan plus dex treatment. I was particularly interested in your comments about melphalan plus prednisone vs melphalan plus dex.
As regards the increase in problems with the blood counts, my doctor has ordered frequent blood draws to closely monitor that side effect even with the lower dex dosage. She has also wisely given me a prescription for Compazine (prochlorperazine) just to have on hand in case of excessive nausea. Looks like she knows what she is doing.
I am glad she did not order the prednisone, else we might have had a bit of a tussle. I was on high-dose prednisone for a different ailment in the past and the side effects of that stuff made my life a living hell. Not to mention the drawn out withdrawal period involved with coming down off that stuff.
My blood sugar shot up over 500 and I was shooting insulin 3 times a day. I would eat anything that did not try to eat me first and turned into a 300 pound chipmunk. I grew such a buffalo hump I was ready to start ringing church bells. Talk about riding a tiger, the real problems start when you try to get off.
The withdrawal from prednisone has to be very gradual so I kept suffering the side effects long after the medication had accomplished its original goal.
At first I was afraid I might not be regarded as a team player since I declined the offer of a stem cell transplant despite the pep talk I got from her compadre. She understands that my personal goal is to have as little hassle and as much of that overused term, quality of life, as I can get. Longevity is not a big issue for me at my age considering my other physical problems.
Grizlump
Thanks for your informative response to my inquiry about melphalan plus dex treatment. I was particularly interested in your comments about melphalan plus prednisone vs melphalan plus dex.
As regards the increase in problems with the blood counts, my doctor has ordered frequent blood draws to closely monitor that side effect even with the lower dex dosage. She has also wisely given me a prescription for Compazine (prochlorperazine) just to have on hand in case of excessive nausea. Looks like she knows what she is doing.
I am glad she did not order the prednisone, else we might have had a bit of a tussle. I was on high-dose prednisone for a different ailment in the past and the side effects of that stuff made my life a living hell. Not to mention the drawn out withdrawal period involved with coming down off that stuff.
My blood sugar shot up over 500 and I was shooting insulin 3 times a day. I would eat anything that did not try to eat me first and turned into a 300 pound chipmunk. I grew such a buffalo hump I was ready to start ringing church bells. Talk about riding a tiger, the real problems start when you try to get off.
The withdrawal from prednisone has to be very gradual so I kept suffering the side effects long after the medication had accomplished its original goal.
At first I was afraid I might not be regarded as a team player since I declined the offer of a stem cell transplant despite the pep talk I got from her compadre. She understands that my personal goal is to have as little hassle and as much of that overused term, quality of life, as I can get. Longevity is not a big issue for me at my age considering my other physical problems.
Grizlump
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Grizlump - Name: Charlie
- Who do you know with myeloma?: me
- When were you/they diagnosed?: June 2014
- Age at diagnosis: 67
Re: Melphalan and dexamethasone treatment: what to expect?
Glad I could help, Charlie. Good luck with the treatment regimen. I will be interested to hear how it goes for you.
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