Hi Myeloma Beacon Staff, this is my first time to add something to your news. I am an avid reader of your newsletters and it is so interesting the things you put in your articles, I would like to thank you very much for helping me to understand something that a couple of years ago, I never even heard of: multiple myeloma.
My husband was diagnosed two years ago in Nov 2008, with Multiple Myeloma, his light chains where 6000 (this is in Australia, I noticed measurements vary from country to country), he had multiple bone involvement, high calcium, also tested to have T4:14 translocation.
He has undergone VAD, Thalidomide – Dexamethasone, stem cell transplant, all treatments were successful, but only a short time with remission, his counts are now back up to 1300 again, and his doc wants to try the Revlimid-dexamethasone treatment
My question is, is it the best way to go for T4;14 patient, or is the Velcade more successful. And how long is the response rate for a high risk patient, his response for Stem cell was less than 6 months. Thank again for your excellent articles.
Moderator note: This question originally was posted as a comment on this article,
https://myelomabeacon.org/news/2011/05/27/certain-chromosomal-abnormalities-may-negatively-affect-prognosis-in-relapsed-and-refractory-myeloma-patients-receiving-revlimid-lenalidomide-dexamethasone-therapy
but was moved here so it might have a better chance of being answered.
Forums
6 posts
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Re: Teatment for t4;14 patient who responds well, but briefl
It does appear that your husband is relpasing. It is unfortunate that the transplant did not offer a longer/better time to progression. Your question regarding t(4;14). Yes it does denote high risk myeloma and as you are learning high risk can respond quite well, the problem is that relapse occurs more quickly.
When deciding what therapy(ies) to initiate at relapse a number of clinical aspects must be taken into account. So, without knowing your husbands case in detail I cannot saw what I would recommend in his case. Overall health, neuropathy, distance from infusion center, social issues, convenience etc ... That being said, you are also correct in stating that Velcade (bortezomib) may have a better effect in patients with high risk cytogenetics. Most of the data suggests that if t(4:14) Velcade should be part of therapy. It is important to note that 1) Velcade improves progression free survival in most patients with t(4;14), but these individuals remains at greater risk then standard risk patients; 2) these data are based on populations of patients and not individuals. In your husbands case to relapse within 6 months of HDM-ASCT suggests additional high risk factors that we are note able to assess.
Subcutaneous Velcade and dexamethasone would be an excellent option. Revlimid and dex is also an excellent combination. And the goals are now to control disease the best we can. So, at some point your husband will need either one of these therapies (or combination therapies).
When deciding what therapy(ies) to initiate at relapse a number of clinical aspects must be taken into account. So, without knowing your husbands case in detail I cannot saw what I would recommend in his case. Overall health, neuropathy, distance from infusion center, social issues, convenience etc ... That being said, you are also correct in stating that Velcade (bortezomib) may have a better effect in patients with high risk cytogenetics. Most of the data suggests that if t(4:14) Velcade should be part of therapy. It is important to note that 1) Velcade improves progression free survival in most patients with t(4;14), but these individuals remains at greater risk then standard risk patients; 2) these data are based on populations of patients and not individuals. In your husbands case to relapse within 6 months of HDM-ASCT suggests additional high risk factors that we are note able to assess.
Subcutaneous Velcade and dexamethasone would be an excellent option. Revlimid and dex is also an excellent combination. And the goals are now to control disease the best we can. So, at some point your husband will need either one of these therapies (or combination therapies).
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Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Teatment for t4;14 patient who responds well, but briefl
My mother also has FISH detected t(4;14) as well as monosomy 13 detected by FISH. By conventional flow cytometry, she is 46xx with no cytogenetic abnormalities detected. After completing one cycle of treatment with Rev/Dex, she achieved a 40% decrease in in M spike. Her hematologist/oncologist wants to keep her on Rev/Dex for at least 8 months. She is 71 and in very good physical condition, but is strongly against having a stem cell transplant if at all possible (personal choice).
We are extremely grateful that she seems to tolerate Rev/Dex well and appears to be responding well, however, as I've read and you've confirmed, t(4;14) is usually associated with a short duration response.
My question is this: Since Velcade has been shown to be particularly effective for high risk cytogenetics, should it be part of the initial treatment (in combination with Rev/Dex), or is it better to wait until patient relapses and/or becomes refractory to other treatments before trying it? ... or does the order in which treatments are administered even make a difference in your opinion?
Thank you so much for ALL your help and expertise!!!
Lisa B.
We are extremely grateful that she seems to tolerate Rev/Dex well and appears to be responding well, however, as I've read and you've confirmed, t(4;14) is usually associated with a short duration response.
My question is this: Since Velcade has been shown to be particularly effective for high risk cytogenetics, should it be part of the initial treatment (in combination with Rev/Dex), or is it better to wait until patient relapses and/or becomes refractory to other treatments before trying it? ... or does the order in which treatments are administered even make a difference in your opinion?
Thank you so much for ALL your help and expertise!!!
Lisa B.
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Lisa B. - Name: Lisa B.
- Who do you know with myeloma?: My mother, Barbara Henson
- When were you/they diagnosed?: 10-28-11
- Age at diagnosis: 71
Re: Teatment for t4;14 patient who responds well, but briefl
Dear LisaB,
With a 40% drop in the M spike after 1 cycle, I would not recommend a change in therapy. That is terrific!
When Revlimid (lenalidomide)/dexamethasone is used as primary therapy without a transplant in the wings, there is no defined duration of therapy. Given the fact that your mother has higher risk disease, sustained (indefinite) therapy should be considered. In a case like this, I might treat with Revlimid and dex for out to 1 year and then stay on single agent Revlimid indefinitely, provided she is tolerating therapy reasonably well.
No one knows whether the addition of Velcade (bortezomib) at this point is more advantageous (compared with a sequential approach). An on-going phase 3 study comparing Revlimid/dex to Revlimid/Velcade/dex will hopefully answer this important question. Once again, given the good initial response, I would suggest sticking with the Revlimid/dex and reserving Velcade for the next line of therapy.
Hope this helps. Good luck!
Pete V.
With a 40% drop in the M spike after 1 cycle, I would not recommend a change in therapy. That is terrific!
When Revlimid (lenalidomide)/dexamethasone is used as primary therapy without a transplant in the wings, there is no defined duration of therapy. Given the fact that your mother has higher risk disease, sustained (indefinite) therapy should be considered. In a case like this, I might treat with Revlimid and dex for out to 1 year and then stay on single agent Revlimid indefinitely, provided she is tolerating therapy reasonably well.
No one knows whether the addition of Velcade (bortezomib) at this point is more advantageous (compared with a sequential approach). An on-going phase 3 study comparing Revlimid/dex to Revlimid/Velcade/dex will hopefully answer this important question. Once again, given the good initial response, I would suggest sticking with the Revlimid/dex and reserving Velcade for the next line of therapy.
Hope this helps. Good luck!
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Teatment for t4;14 patient who responds well, but briefl
Hi Dr. Vorhees!!
Your response helps tremendously, as always!! Thank you so much!!
It's very reassuring to me to know that you're in agreement with Rev/Dex as initial treatment. She does seem to be responding quite well!!! I'm anxious to discuss the "sustained treatment" option with her doctor. I know that Mom wouldn't be opposed as long as she continues to tolerate it as well as she is currently.
THANK YOU again, Dr. Voorhees!
Your response helps tremendously, as always!! Thank you so much!!
It's very reassuring to me to know that you're in agreement with Rev/Dex as initial treatment. She does seem to be responding quite well!!! I'm anxious to discuss the "sustained treatment" option with her doctor. I know that Mom wouldn't be opposed as long as she continues to tolerate it as well as she is currently.
THANK YOU again, Dr. Voorhees!
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Lisa B. - Name: Lisa B.
- Who do you know with myeloma?: My mother, Barbara Henson
- When were you/they diagnosed?: 10-28-11
- Age at diagnosis: 71
Re: Teatment for t4;14 patient who responds well, but briefl
Hello Dr Voorhees!!
You stated:
An on-going phase 3 study comparing Revlimid/dex to Revlimid/Velcade/dex will hopefully answer this important question.
How does this trial design answer sequential therapy vs combination therapy?
You stated:
An on-going phase 3 study comparing Revlimid/dex to Revlimid/Velcade/dex will hopefully answer this important question.
How does this trial design answer sequential therapy vs combination therapy?
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suzierose - Name: suzierose
- When were you/they diagnosed?: 2 sept 2011
6 posts
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