[Eric Hofacket]

Revlimid without Dex for maintenance chemo, bad idea?

by Eric Hofacket on Wed Sep 05, 2012 12:46 am

I had my SCT last October and achieved a near complete response. My immunofixation showed just a faint sign of monoclonal protein post SCT. A few months after SCT I started Revlimid without Dexamethasone for maintenance chemotherapy. I had asked if I could not be put on Dexamethasone if possible because the side effects I was experiencing, not sleeping for up to two days, made life and work difficult, but I made it clear that if it was felt that it was necessary then I was willing to do both Revlimid and Dexamethasone.

Since I have just been put on Revlimid I achieved a complete response, no signs on immunofixation or any other blood test, but I have not had a bone marrow biopsy post SCT. The last biopsy I had before SCT showed very low levels of abnormal plasma cells and not enough to do a FISH.

The usual maintenance chemotherapy is for both Revlimid and Dexamethasone and all the clinical trial studies for Revlimid I have been able to find, which all had good results, were for both Revlimid and Dexamethasone, not Revlimid alone.

Am I making a mistake not taking Dexamethasone? Can this question even really be answered in the absence of any studies I am aware of just using Revlimid?

My thinking is that if I obtained CR with just Revlimid, then stay with that for now. By not taking Dexamethasone now I may be delaying the onset of developing myeloma that is resistant to Dexamethasone, and when I eventually relapse in the future Dexamethasone will still be effective when I have to start it again. I know of no studies that support my assumptions, they are just my speculation.

As a broader post SCT maintenance chemotherapy strategy, if a CR is achieved is it better to use minimal therapy and chemo to maintain the CR to prevent the onset of drug resistance and preserve the potency of as many myeloma therapy drugs as possible for latter potential use? My understanding is in time all the drugs become less effective.

[jennifrp]

Re: Revlimid without Dex for maintenance chemo, bad idea?

by jennifrp on Wed Sep 05, 2012 1:43 pm

Hey Eric,

The studies that I've seen are just on Rev. Here are two for you:

https://meetinglibrary.asco.org/content/43089-74

https://meetinglibrary.asco.org/content/41503-74

I've had two auto transplants, the first in 2007 with no maintenance then again in 2011 this time I've been on 10mg of Rev each month. My protein level tests sometimes say that a protein is detected (but not enough to quantify it) and sometimes it says there's no protein detected. The lab results have small variations in them.

Jen

[coop223]

Re: Revlimid without Dex for maintenance chemo, bad idea?

by coop223 on Mon Mar 25, 2013 3:14 pm

No Dex, just 10mg Revlimid for maintenance for me. Its been one year since my sct. I go down in three weeks for labs and a bone marrow biopsy to see how I am.

[Dr. Jason Valent]

Re: Revlimid without Dex for maintenance chemo, bad idea?

by Dr. Jason Valent on Mon Mar 25, 2013 4:55 pm

Agree with maintenance without dex. The post transplant studies (French and US) did not use dexamethasone. Articles are in New England Journal of Medicine May 2012.

[Beacon Staff]

Re: Revlimid without Dex for maintenance chemo, bad idea?

by Beacon Staff on Tue Mar 26, 2013 9:34 am

The Beacon published a detailed summary of the articles about Revlimid and maintenance therapy that were published in the New England Journal of Medicine last May. Here is a link to the Beacon's summary:

https://myelomabeacon.org/news/2012/05/11/revlimid-lenalidomide-maintenance-therapy-studies-clarify-benefits-and-risks/