[michelle26]

multiple myeloma not responding to treatment

by michelle26 on Wed Sep 07, 2011 1:48 am

Hi ,

I am hoping that someone can help. I am very worried. My dad, 68, has multiple myeloma diagnosed in February 2011, type IgAk. He was on 2 cycles of VAD and 6 cycles of Velcade+Dexamethasone.

His disease did not respond to treatment, his blood count is very low (he gets transfusions), we had a very mild response for the IgA numbers and the cancer cells in the bone marrow have increased substantially. From the blood work the doc says that some plasma cells moved into the blood system and therefore the multiple myeloma might evolve into plasma cell leukemia which I've read is a very aggressive type of multiple myeloma. His doctor is not very optimistic about future treatment. Basically because of his current blood work the doctor is not sure which treatment to use. They're thinking about adding an extra drug (cytoxan) to the Velcade (news) and dex. But if Velcade+dex is not working what are the chances of this working? The doc also mentioned Thalidomide (news) but said not an option now because of current blood work.

Thank you.

[Dr. Ken Shain]

Re: multiple myeloma not responding to treatment

by Dr. Ken Shain on Fri Sep 09, 2011 9:45 am

I am sorry to hear that your father's disease is not responding well to therapy- it is an unfortunate situation. First, if available, I would ask that your oncologist (or you seek) refer your father to a myeloma specialist. Second, there are additional therapies that may be implemented- additional drugs for instance. Cytoxan is a good choice to add to the Velcade and dex; alternately, Revlimid (news) may be added as the third drug. The use of 4 drugs (cytoxan, Velcade, Revlimid, and dex) or even more aggressive combination therapies may also be used depending on the clinical setting. How aggressive to be with therapy is a balance between the disease, the patient's wishes, and his/her ability to tolerate therapy. If he is a potential transplant candidate then erring on the side of aggressive may be warrented. Refractory disease is a difficult situation and, therefore, clinical trials may be an avenue if he remains a candidate.

I would discuss this with his oncologist and, again, I would highly recommend you seek an opinion from a myeloma specialist, where more options and experience with those options may be available.

[michelle26]

Re: multiple myeloma not responding to treatment

by michelle26 on Sat Sep 10, 2011 2:13 am

Dear Dr. Shain ,

thank you so much for your answer. The doc suggested DT-PACE which I've read is a very aggressive combination of drugs. I worry that dad will not make it through this treatment given how aggressive the treatment is and given his current blood work. Dad was a candidate for transplant before the disease progressed. Do you think that thalidomide and dex could be an option?

I already contacted a specialist but I don't know if we have enough time to switch to another doctor. I am looking into clinical trials, I've read about pomalidomide (news), but it takes time to get enrolled and his current doctor says that we need to start treatment right away.

Thank you again,

Michelle