My wife was recently diagnosed with aggressive multiple myeloma with multiple higher-risk chromosomal abnormalities; deletion 1p, gain 1q21, monosomy 13, and t(4;14).
Some studies I've read indicate having multiple risk factors is not a good thing. These studies don't include the use of novel agents in therapy currently used today. My wife is completing Revlimid, Velcade, and dexamethasone (RVD) induction therapy and will undergo an autologous stem cell transplant soon. She seems to be responding well to the therapy and we're encouraged by her initial response.
I was wondering if it's common for those diagnosed with t(4;14) or deletion 17 to also have other risk factors they don't mention? Or do most have only one risk factor when discussing cytogenetic risk?
Is there anyone with multiple risk factors like my wife's that would share how they are doing?
Wayne
Forums
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wemery - Name: Wayne Emery
- Who do you know with myeloma?: Wife Nancy Emery
- When were you/they diagnosed?: March 2016
- Age at diagnosis: 66
Re: Multiple higher-risk chromosomal abnormalities
Hi Wayne.
My understanding is that there are also other things to consider. For example, according to a Mayo study, being hyperdiploid may help overcome the impact of the chromosome abnormalities. Also important is LDH and beta-2 microglobulin. If these numbers are in normal range, the outlook is better.
Also, don't discount the hope we all share with the newer drugs that have recently been approved. Some of the monoclonal antibodies work well regardless of chromosome issues.
It's great that your wife has responded well. However, maintenance will be important after transplant.
Best wishes to you both on the upcoming transplant. May you both enjoy many, many years of deep remission. Stay on track and remember that we all have good reason to be hopeful.
My understanding is that there are also other things to consider. For example, according to a Mayo study, being hyperdiploid may help overcome the impact of the chromosome abnormalities. Also important is LDH and beta-2 microglobulin. If these numbers are in normal range, the outlook is better.
Also, don't discount the hope we all share with the newer drugs that have recently been approved. Some of the monoclonal antibodies work well regardless of chromosome issues.
It's great that your wife has responded well. However, maintenance will be important after transplant.
Best wishes to you both on the upcoming transplant. May you both enjoy many, many years of deep remission. Stay on track and remember that we all have good reason to be hopeful.
Re: Multiple higher-risk chromosomal abnormalities
Hi Wayne:
The whole concept of cytogenetic abnormalities is very complicated, and not conducive to short answers. I am somewhat familiar with t 4,14 however, and will give a couple of quick thoughts. This I think is your wife's primary issue. T 4,14 is prone to anemia, and not bone damage. It historically did not do any worse with respect to response, but was prone to quick relapses. Velcade was found to partially or totally mitigate it, so after treatment that included Velcade, the approach was for Velcade maintenance. Recent research is that Kyprolis is very good for t 4,14, and also the monoclonal antibodies. We were advised that one should take an ASCT with this condition. My own personal opinion is that it is important to try and get to MRD-, to get a long remission (could be potentially done without an ASCT). Literature is all over the place on this. You will see it called high risk, intermediate risk (MSmart,) and I even heard Dr. Barlogie calling it standard risk, as long as it is identified and treated aggressively enough. Good luck.
The whole concept of cytogenetic abnormalities is very complicated, and not conducive to short answers. I am somewhat familiar with t 4,14 however, and will give a couple of quick thoughts. This I think is your wife's primary issue. T 4,14 is prone to anemia, and not bone damage. It historically did not do any worse with respect to response, but was prone to quick relapses. Velcade was found to partially or totally mitigate it, so after treatment that included Velcade, the approach was for Velcade maintenance. Recent research is that Kyprolis is very good for t 4,14, and also the monoclonal antibodies. We were advised that one should take an ASCT with this condition. My own personal opinion is that it is important to try and get to MRD-, to get a long remission (could be potentially done without an ASCT). Literature is all over the place on this. You will see it called high risk, intermediate risk (MSmart,) and I even heard Dr. Barlogie calling it standard risk, as long as it is identified and treated aggressively enough. Good luck.
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JPC - Name: JPC
Re: Multiple higher-risk chromosomal abnormalities
Hi, sorry to hear about your wife. I find it very nice of you to be researching this for her to help her. Everyone handles serious health matters differently and my husband chose not to research. I think things were hard enough on him trying to be my support.
Anyhow, I'm not really sure I have any answers for you, but I was diagnosed with the t(4:14) abnormality and deletion 17p. It's been about 3 years since diagnosis. I underwent treatment for about 5 months with cyclophosphamide, Velcade, and dexamethasone (CyBorD) and then had an autologous stem cell transplant. I had Velcade maintenance for a year and now only get Zometa. I feel good now and am hopeful for a few more years before relapse.
Best wishes to you and your wife.
Kim
Anyhow, I'm not really sure I have any answers for you, but I was diagnosed with the t(4:14) abnormality and deletion 17p. It's been about 3 years since diagnosis. I underwent treatment for about 5 months with cyclophosphamide, Velcade, and dexamethasone (CyBorD) and then had an autologous stem cell transplant. I had Velcade maintenance for a year and now only get Zometa. I feel good now and am hopeful for a few more years before relapse.
Best wishes to you and your wife.
Kim
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kjpoppit - Name: Kim Nelson
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Sept. 19th, 2013
- Age at diagnosis: 47
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