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Multiple myeloma treatment during tuberculosis treatment?

by UrviL on Mon Jul 03, 2017 3:21 am

Hello everyone!

First time post on the forum. We are from India. My mother was diagnosed with myeloma in September 2015 and since then has gone through the following treatments:

  • Started treatment with bortezomib (Velcade) and cyclophosphamide till January 2016
  • Started with Thalidomide and inj. zoledronic acid (Zometa)
  • Underwent radiotherapy for local lesions in right knees in May 2016
  • Stem cell transplant in June 2016
  • Treatment with bortezomib, Graniset, dexamethasone, Rantac (Zantac, ranitidine) in November 2016
Her myeloma is quite aggressive in nature as per our oncologist. According to the FISH report, it shows a 14q deletion / monosomy 14, 13q deletion and TP53 deletion. My mother, as far as I can understand, had a partial response to the stem cell transplant. She had a minor M-spike in December 2016. She was put on lenalidomide (Revlimid) maintenance in January 2016.

In the first week of May, she started having an extreme pain in the sinus area, which turned out to be a soft tissue mass in one side of her maxillary sinus area. A biopsy showed that the mass was in fact from multiple myeloma. This was baffling to us since it was not in the bone as usually seen with myeloma.

She went through 11 radiations for the mass, which has now appeared to reduce. The pain has completely gone. Immediately after the radiation, she started having a recurrent low grade fever spikes (up to 100.8 F / 38.2 C). Our oncologist had a tough time figuring out what was going on. He suspected an infusion port infection, but tests for that have come back negative.

Finally, two CT scans and a bronchoscopy later, she has been diagnosed with tuberculosis after they found two nodules in her lungs and enlarged lymph nodes.

We are quite worried about this new development since this means she might have to go on tuberculosis treatment and off her maintenance therapy. We think there must be an alternative way to treat the tuberculosis without stopping the therapy for the multiple myeloma.

Is it possible to continue treatment for the multiple myeloma while also having the tuberculosis treated?

UrviL
Name: Urvi Lakhani
Who do you know with myeloma?: Mother
When were you/they diagnosed?: Sept 2015
Age at diagnosis: 51

Re: Multiple myeloma treatment during tuberculosis treatment

by Nancy Shamanna on Tue Jul 04, 2017 8:15 am

Hello Urvil,

Welcome to the forum, but as ever here, sorry that you need to seek out information for prob­lems concerning multiple myeloma.

It sounds like your mother is fighting a lot of disease, having tuberculosis I am not a doctor, but I did find the following scholarly article about patients having both diseases:

Tsai, YC, et al, "Tuberculosis meningitis in patient with multiple myeloma during bortezomib-containing therapy," The Kaohsiung Journal of Medical Sciences, October 2016 (full text of article)

In my case, having had treatment for another cancer besides myeloma, my doctors conferred with each other as to the best course of treatment. This meant that I was seeing my hemato­logi­cal oncologist, a medi­cal oncologist, a radiologist, and a surgeon! I was very im­pressed as to how they could work out a good course of treatment, and I hope it is the same for your mother.

Nancy Shamanna
Name: Nancy Shamanna
Who do you know with myeloma?: Self and others too
When were you/they diagnosed?: July 2009

Re: Multiple myeloma treatment during tuberculosis treatment

by UrviL on Tue Jul 04, 2017 12:38 pm

Thank you for your kind reply, Nancy. It feels wonderful to connect with people who are going through the same thing.

Yes, my mother is going through a lot with myeloma itself and now with the suspected tuber­cu­losis. We are most worried because she has to go off myeloma treatment for a while to get treated for the tuberculosis. With her myeloma already being quite aggressive and resistant to treatment.

UrviL
Name: Urvi Lakhani
Who do you know with myeloma?: Mother
When were you/they diagnosed?: Sept 2015
Age at diagnosis: 51

Re: Multiple myeloma treatment during tuberculosis treatment

by UrviL on Thu Jul 06, 2017 6:07 am

Our doctor has now started treatment with prednisolone for my mother. There is still a recurrent fever, continuously brought down by paracetamol (Tylenol, acetaminophen) injections. All trachea sputum cultures for tuberculosis have come negative. We are still unsure of the reason of the fever. It's been almost 6 weeks now.

UrviL
Name: Urvi Lakhani
Who do you know with myeloma?: Mother
When were you/they diagnosed?: Sept 2015
Age at diagnosis: 51


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