My husband was diagnosed with multiple myeloma (IgA lambda) in August 2015. He was on cyclophosphamide, Velcade, and dex (CyBorD) until February 2016 at which time he had a stem cell transplant.
By the beginning of June 2016, it was clear the stem cell transplant had not worked. He was then put on Revlimid. That worked until October 2016. In December 2016, he was put on the new drug Darzalex. It is now Feb 7, 2017 and the Darzalex is not working either. The next drug to go to is Pomalyst (pomalidomide, Imnovid).
I am just wondering what other options there might be, and which might be best to pursue.
Thanks.
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MaD - Name: MaD
- Who do you know with myeloma?: my husband
- When were you/they diagnosed?: August 2015
- Age at diagnosis: 63
Re: Options after CyBorD, transplant, Revlimid & Darzalex?
Similar to my father. Are they also giving 40 mg dexamethasone and trying combinations of drugs concurrently? My dad is adding Farydak (panobinostat), Darzalex, Velcade, and dexamethasone this week.
How are your husband's kidneys doing? My dad's went crazy for the first time in 5 years, with his creatinine hovering at 4.0. Before they decided on Farydak, they were going to do high-dose IV Cytoxan (cyclophosphamide), but that felt risky due to no more stem cells to regenerate fresh replacement cells.
I feel your pain and know how hard it is.
How are your husband's kidneys doing? My dad's went crazy for the first time in 5 years, with his creatinine hovering at 4.0. Before they decided on Farydak, they were going to do high-dose IV Cytoxan (cyclophosphamide), but that felt risky due to no more stem cells to regenerate fresh replacement cells.
I feel your pain and know how hard it is.
Re: Options after CyBorD, transplant, Revlimid & Darzalex?
I would suggest some caution when it comes to high-dose dexamethasone as a routine treatment recommendation for myeloma patients, whether newly diagnosed or late-stage.
There is a reason the high-dose regimen, involving doses such as 40 mg four times a week, is not that common these days. The high-dose regimen may be very effective in reducing the myeloma tumor load, and there certainly are times when it should be considered. However, a key study published in 2010 clearly demonstrated that the better response associated with high-dose dexamethasone does not translate into better overall survival:
Rajkumar, SV, et al, "Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial," Lancet Oncology, Jan 2010 (abstract; full text at PubMed Central)
Granted, this study involved newly diagnosed patients. High-dose dexamethasone may have a role in patients who need a quick response, or a bridge to some other therapy, or who tolerate dexamethasone very well. However, the study's outcome made clear that deeper responses do not always translate to better survival – particularly when the deeper responses come at the cost of higher side effects (as they often do).
There is a reason the high-dose regimen, involving doses such as 40 mg four times a week, is not that common these days. The high-dose regimen may be very effective in reducing the myeloma tumor load, and there certainly are times when it should be considered. However, a key study published in 2010 clearly demonstrated that the better response associated with high-dose dexamethasone does not translate into better overall survival:
Rajkumar, SV, et al, "Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial," Lancet Oncology, Jan 2010 (abstract; full text at PubMed Central)
Granted, this study involved newly diagnosed patients. High-dose dexamethasone may have a role in patients who need a quick response, or a bridge to some other therapy, or who tolerate dexamethasone very well. However, the study's outcome made clear that deeper responses do not always translate to better survival – particularly when the deeper responses come at the cost of higher side effects (as they often do).
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Jonah
Re: Options after CyBorD, transplant, Revlimid & Darzalex?
The Darzalex has been stopped. This coming week he will go on Pomalyst (pomalidomide), cyclophosphamide, and dexamethasone. So far his kidneys are doing fine.
Hoping this will work
Hoping this will work
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MaD - Name: MaD
- Who do you know with myeloma?: my husband
- When were you/they diagnosed?: August 2015
- Age at diagnosis: 63
Re: Options after CyBorD, transplant, Revlimid & Darzalex?
He has been on pomalidomide (Pomalyst, Imnovid), cyclophosphamide, and dexamethasone now for three weeks. He has greatly improved. His blood results are improving; not within normal range, for sure, but heading in the right direction.
While on the Darzalex he became worse by the day. Not sure if it was the multiple myeloma or the Darzalex. But given that he has improved so much since stopping it, I am thinking that Darzalex was not the right drug for him.
While on the Darzalex he became worse by the day. Not sure if it was the multiple myeloma or the Darzalex. But given that he has improved so much since stopping it, I am thinking that Darzalex was not the right drug for him.
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MaD - Name: MaD
- Who do you know with myeloma?: my husband
- When were you/they diagnosed?: August 2015
- Age at diagnosis: 63
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