Everyone,
Diagnosed last April, w/out lesions but a Hemoglobin of 4.0--also diagnosed with Pure Red Cell Aplasia--ultimately 19 units transfused. By July: Four cycles of Vel-Thal(50 mg)-Dex lowered the counts from 1.60 monoclonal and a 2345 count to .50 and 650 AND eliminated the PRCA!
Another 2.5 cycles only reduced the monoclonal protein to .28. So perhaps the Vel has run its course. No chemo treatments from mid-August to autogolous SCT on Sept. 21st.
No chemo for 90 days after the melphalan and SCTA. Just got back 1st protein tests: monoclonal was up to .30 and a 920 count. My questions are these: what is the best treatment at this point: a maintenance 10-15 of Rev and Dex or something more aggressive?
Am I in relapse at this point--do I have an angry MM--or should we just wait and see what happens. Has Velcade likely run its effective course? How effective has the new Velcade based drug the FDA will approve this summer been in this type of situation?
Lower back pain the past couple of weeks with another MRI set for next week.
Thanks for sharing your time and insights. Happy New Year!
Forums
4 posts
• Page 1 of 1
Re: Bit of a Quandary or Just Unusual
Pawnee3212,
You have had a partial response to treatment with velcade-thal-dex (>50% reduction in M-protein from baseline), and continue to be in partial remission after your stem cell transplant. There is no significant difference between an M-protein of 0.28 and 0.30; this is within the normal variation of the test. Unless there is some other evidence that the myeloma is becoming more active (e.g. new bone lesions, worsening kidney function), there's nothing to suggest you are relapsing at this time.
The question of what to do now is currently one of the most hotly debated topics in the myeloma field. The options range from just close observation, to low dose maintenance, to consolidation with additional combination therapy or even another stem cell transplant. In fact, a large clinical trial in the US (called BMT-CTN 0702) is currently trying to answer this question and may be a good option for you to consider. Outside of a trial, this is really an individualized decision made by each patient with his/her doctor, taking into account prognostic factors like cytogenetics and ISS stage, toxicities from prior treatments and other medical problems, and personal preference. Data from 2 large randomized trials have shown that low dose (10-15mg) daily lenalidomide can delay progression after transplant by a median of 18 months, so this is certainly something to consider and discuss with your doctor. Consultation with a myeloma specialist may help you sort through the various options and reach a decision.
Finally, there is no data yet regarding the use of carfilzomib, the 2nd generation proteasome inhibitor similar to Velcade, as post-transplant maintenance, though it certainly is active in patients with relapsed disease.
Hope this is helpful.
You have had a partial response to treatment with velcade-thal-dex (>50% reduction in M-protein from baseline), and continue to be in partial remission after your stem cell transplant. There is no significant difference between an M-protein of 0.28 and 0.30; this is within the normal variation of the test. Unless there is some other evidence that the myeloma is becoming more active (e.g. new bone lesions, worsening kidney function), there's nothing to suggest you are relapsing at this time.
The question of what to do now is currently one of the most hotly debated topics in the myeloma field. The options range from just close observation, to low dose maintenance, to consolidation with additional combination therapy or even another stem cell transplant. In fact, a large clinical trial in the US (called BMT-CTN 0702) is currently trying to answer this question and may be a good option for you to consider. Outside of a trial, this is really an individualized decision made by each patient with his/her doctor, taking into account prognostic factors like cytogenetics and ISS stage, toxicities from prior treatments and other medical problems, and personal preference. Data from 2 large randomized trials have shown that low dose (10-15mg) daily lenalidomide can delay progression after transplant by a median of 18 months, so this is certainly something to consider and discuss with your doctor. Consultation with a myeloma specialist may help you sort through the various options and reach a decision.
Finally, there is no data yet regarding the use of carfilzomib, the 2nd generation proteasome inhibitor similar to Velcade, as post-transplant maintenance, though it certainly is active in patients with relapsed disease.
Hope this is helpful.
-
Dr. Adam Cohen - Name: Adam D. Cohen, M.D.
Beacon Medical Advisor
Re: Bit of a Quandary or Just Unusual
Dr. Cohen,
Thanks for the response. It looks like we'll start with 10 or 15 Rev next week. Just for information: is it rare for aSCT to not further lower the M-protein if there are not crytogenetic abnormalities? My crytogenetics tests are all negative. Thanks again and Happy New Year.
Pawnee
Thanks for the response. It looks like we'll start with 10 or 15 Rev next week. Just for information: is it rare for aSCT to not further lower the M-protein if there are not crytogenetic abnormalities? My crytogenetics tests are all negative. Thanks again and Happy New Year.
Pawnee
-
pawnee3212
Re: Bit of a Quandary or Just Unusual
Hi! I can't comment on your diagnsosi numbers as I don't really know what you are talking about.
I just wanted to say that about three months after my transplant I still had a M-protein of about 3 (I'm in Canada so I think that is the same as your .3) which is pretty low, I was diagnosed with a really high M-protien. We were pleased with my good partial response! and my doctor talked about this < 90% reduction as succesful transplant. Then as per my doctors suggestion (the high dose chemo stays active in your body for months after transplant) it continued to drop and is now undetectable 18 months later! don' worry to much it sounds like you have ha a good response to the transplant. I chose not to take the maintenence that was offered me and am enjoying no chemo or anthing for as long as I can!
I just wanted to say that about three months after my transplant I still had a M-protein of about 3 (I'm in Canada so I think that is the same as your .3) which is pretty low, I was diagnosed with a really high M-protien. We were pleased with my good partial response! and my doctor talked about this < 90% reduction as succesful transplant. Then as per my doctors suggestion (the high dose chemo stays active in your body for months after transplant) it continued to drop and is now undetectable 18 months later! don' worry to much it sounds like you have ha a good response to the transplant. I chose not to take the maintenence that was offered me and am enjoying no chemo or anthing for as long as I can!
-
tatgirl
4 posts
• Page 1 of 1
Return to Treatments & Side Effects