Dr. McCarthy, In 2007 I had an auto SCT with a remission until 2009. I'm now on Rev & Dex and am probably going to have a 2nd SCT next year. I've been offered a clinical trial that uses busulfan (4 days) and Velcade (1 day) instead of melphalan, which is what was used last time. Could you share your thoughts on busulfan for multiple myeloma? This is a becoming a difficult decision.
Thank you,
Jen (35 yrs old)
Forums
2 posts
• Page 1 of 1
-
jennifrp - Name: Jen
- Who do you know with myeloma?: me
- When were you/they diagnosed?: 2006
- Age at diagnosis: 31
Re: Clinical Trial with Busulfan
Hi Jen,
The reason for this trial is to see if Busulfan and Velcade would be a better treatment than high dose melphalan. Melphalan is a drug with activity against multiple myeloma whereas it is hoped that the busulfan with Velcade will be as good, if not better. Busulfan alone does not have as much activity against multiple myeloma as melphalan. So, I am a bit of a traditionalist and favor melphalan but I do not have the busulfan/Velcade protocol (which I believe is sponsored by Otsuka Pharmaceuticals) as to rationale and the preclinical and other clinical data. As you know there is plenty of data showing the efficacy of bortezomib (Velcade) but this is a short course combined with busulfan. (I think it is a single dose) So, this is a difficult decision and there is no right or wrong answer in this situation. As you have had recurrent disease after the first autotransplant, investigational approaches are reasonable to see if you can get a better response. If the disease were high risk such as containing the 4:14 or 17p- abnormalities or even del 13 abnormalities, then an allogeneic transplant could be considered. It would be worth asking if more stem cells could be stored so as to make sure your marrow could tolerate future therapies. I assume that you have not been treated with pomalidomide or carfilzomib. So there are lots of options for you in the future if the disease were to return again. Good luck with your therapy and whatever decision you make, it will be a good one.
The reason for this trial is to see if Busulfan and Velcade would be a better treatment than high dose melphalan. Melphalan is a drug with activity against multiple myeloma whereas it is hoped that the busulfan with Velcade will be as good, if not better. Busulfan alone does not have as much activity against multiple myeloma as melphalan. So, I am a bit of a traditionalist and favor melphalan but I do not have the busulfan/Velcade protocol (which I believe is sponsored by Otsuka Pharmaceuticals) as to rationale and the preclinical and other clinical data. As you know there is plenty of data showing the efficacy of bortezomib (Velcade) but this is a short course combined with busulfan. (I think it is a single dose) So, this is a difficult decision and there is no right or wrong answer in this situation. As you have had recurrent disease after the first autotransplant, investigational approaches are reasonable to see if you can get a better response. If the disease were high risk such as containing the 4:14 or 17p- abnormalities or even del 13 abnormalities, then an allogeneic transplant could be considered. It would be worth asking if more stem cells could be stored so as to make sure your marrow could tolerate future therapies. I assume that you have not been treated with pomalidomide or carfilzomib. So there are lots of options for you in the future if the disease were to return again. Good luck with your therapy and whatever decision you make, it will be a good one.
-
Dr. Philip McCarthy - Name: Philip McCarthy Jr., M.D.
2 posts
• Page 1 of 1
Return to Treatments & Side Effects