Welcome to the forum, MMJ.
Multibilly has been very generous and thorough in the advice he's given you so far. He is really an excellent resource. So I don't have a lot to add. There are just a few points I'd like to have kept in mind during this discussion.
One is that, if you mother is going to take a limited number of Velcade treatment cycles due, for example, to the drug's cost, your doctor's advice to give Velcade by infusion may make sense. Subcutaneously injecting Velcade definitely lowers how often patients experience peripheral neuropathy when treated with the drug, and this is especially important in countries like the U.S., where doctors frequently give the drug for an extended number of treatment cycles -- sometimes even continuously, without interruption, as maintenance therapy.
But there is evidence that, particularly when Velcade is given for a limited number of treatment cycles, giving the drug by infusion can lead to deeper responses. This is discussed in an article here at the Beacon earlier this year,
"Subcutaneous Velcade Leads To Similar Response Rates, But Fewer Side Effects, Compared To IV Velcade In Newly Diagnosed Multiple Myeloma," The Myeloma Beacon, Apr 20, 2015I'm not saying that giving Velcade by infusion is definitely the way to go. I just don't think it should be automatically disregarded as an option.
Also, I think as all of us here think of potential treatment options for your mother, we need to remember the reality that many treatments that are commonly used here in the U.S. – such as Revlimid, Velcade, Kyprolis, and Pomalyst – are either VERY expensive in relation to people's ability to pay, or not even approved, in countries such as Indonesia.
This means it's important to remember older drugs, such as thalidomide (which is cheap, I believe, in countries such as Indonesia), melphalan, doxorubicin, vincristine, dexamethasone, prednisone, cyclophosphamide, etoposide, and even interferon and potentially quinine (!) as treatment options in cases like this.
The key to helping MMJ's mother live as long as possible, and with as good a quality of life, is to come up with a planned sequence of as many different treatments as possible. The treatments can be for now, or for the future, and they need to be feasible.
If you go the Velcade route, MMJ, your mother's doctor may wish to consider Velcade, cyclophosphamide, and dexamethasone (VCD, or "CyBorD") as a combination to use. It is very commonly used in many countries, including the U.S.
If, as it seems may be the case, dexamethasone is not proving very effective, then another Velcade-based option to consider would be Velcade, melphalan, and prednisone (VMP), which also is commonly used in many countries.
If your mother does not get a deep response to her initial treatment regimen, her doctors may wish to consider giving her some consolidation therapy, to further deepen her response. Low-dose prednisone or dexamethasone may be an option for maintenance therapy.
I have not written this with the intention that it be seen as the final word on what treatment your mother should get now...or in the future. I just want to stimulate all of us here to think as openly as possible about the best options for your mother, while recognizing the limitations that may exist.
One final note: If Zometa is expensive in Indonesia, or if you are hesitant to use it, Aredia (pamidronate) is an alternative that is commonly used in the U.S. and other countries. It should be cheap in Indonesia.
Good luck!
