Dear Dr. Bensinger - I was diagnosed in mid-2009 with KFLC myeloma. After one cycle of velcade-dex-cytoxan, my light chains dropped dramatically. I continued with this regimen for an additional 6 cycles. At this point, I am in stringent CR.
What I would like to know is how best to prolong this CR. At diagnosis, FISH detected no abnormalities (e.g., no 4,14, 14,16, 17p loss, del 13q, etc.) and baseline characteristics did not suggest aggressive disease (e.g., normal LDH, low B2M, normal serum creatinine and Hgb, etc.).
In a case like this, would it be best to go on a Velcade maintenance schedule, with one cycle every three months, which would be similar to the Velcade maintenance schedule Dr. Mateos presented at ASH this past December? Or should one consider going on low-dose Revlimid? As for possibly going on Revlimid maintenance, I am wondering if I should instead reserve the drug for the time of relapse because, at this point, I've had a wonderful response with no exposure to an iMid. Or perhaps it's more important to keep the myeloma down now with low-dose Revlimid, with less of an toward relapse.
I will, of course, discuss any opinions you offer with my doctor. Deep gratitude and appreciation for your time and response.
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Re: Prolonging CR with maintenance
Dr. William Bensinger from the Fred Hutchinson Cancer Research Center said:
"It sounds like you have had an excellent response to VCD.
You don't say how old you are but I would give some consideration to autologous stem cell transplant which could improve the depth of your remission. There are no studies, unfortunately, that compare outcomes of patients in remission after initial chemotherapy who then proceed to transplant or not.
You seem to be leaning to a maintenance schedule. The Mateos presentation showed that bortezomib [Velcade] + thalidomide was the best for prolonging progression-free survival but there were no differences in overall survival.
When it comes to maintenance studies, only 1 study using thalidomide after stem cell transplant showed improvements in survival. The subgroup analysis suggested that patients in remission did not benefit from maintenance.
If you do not want to consider a transplant, I would at least consider storing your stem cells (if you are of the appropriate age) and try to enroll in a clinical trial looking at maintenance."
"It sounds like you have had an excellent response to VCD.
You don't say how old you are but I would give some consideration to autologous stem cell transplant which could improve the depth of your remission. There are no studies, unfortunately, that compare outcomes of patients in remission after initial chemotherapy who then proceed to transplant or not.
You seem to be leaning to a maintenance schedule. The Mateos presentation showed that bortezomib [Velcade] + thalidomide was the best for prolonging progression-free survival but there were no differences in overall survival.
When it comes to maintenance studies, only 1 study using thalidomide after stem cell transplant showed improvements in survival. The subgroup analysis suggested that patients in remission did not benefit from maintenance.
If you do not want to consider a transplant, I would at least consider storing your stem cells (if you are of the appropriate age) and try to enroll in a clinical trial looking at maintenance."
Re: Prolonging CR with maintenance
Dear Dr. Bensinger,
Would you please share your thoughts about the international Phase lll clinical trial, IFM 2005 02, where myeloma patients who were treated with Revlimid following an ASCT had superior progression-free survival compared with those who were not treated with Revlimid? Thank you so much for your time and caring.
Linda
Would you please share your thoughts about the international Phase lll clinical trial, IFM 2005 02, where myeloma patients who were treated with Revlimid following an ASCT had superior progression-free survival compared with those who were not treated with Revlimid? Thank you so much for your time and caring.
Linda
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Linda
Re: Prolonging CR with maintenance
Dr. William Bensinger from the Fred Hutchinson Cancer Research Center said:
"There are actually 2 trials which show delays in time to progression with the use of lenalidomide [Revlimid] maintenance after ASCT; the IFM trial 2005-02 and the CALGB trial 100104.
I think both trials are interesting, although no formal manuscript has been published on these results. These results should be interpreted with caution since they are preliminary and as of yet no data shows that lenalidomide [Revlimid] maintenance after ASCT improves overall survival.
It is possible, as shown by some studies using thalidomide maintenance, that use of lenalidomide maintenance may result in a more aggressive, less treatable relapse when it does occur."
"There are actually 2 trials which show delays in time to progression with the use of lenalidomide [Revlimid] maintenance after ASCT; the IFM trial 2005-02 and the CALGB trial 100104.
I think both trials are interesting, although no formal manuscript has been published on these results. These results should be interpreted with caution since they are preliminary and as of yet no data shows that lenalidomide [Revlimid] maintenance after ASCT improves overall survival.
It is possible, as shown by some studies using thalidomide maintenance, that use of lenalidomide maintenance may result in a more aggressive, less treatable relapse when it does occur."
Maintance therapy
I am taking 10mg Revlimid, Where or who would be the best group to follow for the latest information about post ASCT maintance?
Thank you
Mike Benson
Thank you
Mike Benson
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MBenson
Re: Prolonging CR with maintenance
Mike,
There are three ongoing studies looking at Revlimid maintenance after stem cell transplantation:
MM-015 study, which is being conducted by Antonio Palumbo's group in Italy
CALGB 100104 study, which is being conducted by Philip McCarthy's group at the Roswell Park Cancer Institute
French IFM 2005-02 study, which is being conducted by Michel Attal's group in France
There are three ongoing studies looking at Revlimid maintenance after stem cell transplantation:
MM-015 study, which is being conducted by Antonio Palumbo's group in Italy
CALGB 100104 study, which is being conducted by Philip McCarthy's group at the Roswell Park Cancer Institute
French IFM 2005-02 study, which is being conducted by Michel Attal's group in France
Re: Prolonging CR with maintenance
Beacon Staff wrote:Mike,
There are three ongoing studies looking at Revlimid maintenance after stem cell transplantation:
MM-015 study, which is being conducted by Antonio Palumbo's group in Italy
CALGB 100104 study, which is being conducted by Philip McCarthy's group at the Roswell Park Cancer Institute
French IFM 2005-02 study, which is being conducted by Michel Attal's group in France
Is there a typical duration for Revlimid maintance?
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MBenson
Re: Prolonging CR with maintenance
Hi Mike,
Regarding your question about the duration of Revlimid maintenance: We asked Dr. Philip McCarthy of the Roswell Park Cancer Institute about the duration of maintenance in the CALGB study, which he is leading. He said:
"On CALGB 100104: patients remained on maintenance therapy indefinitely until disease progression or intolerance to therapy. This study was a single autotransplant followed by maintenance therapy starting at day 100 after transplant. There are patients who have remained on maintenance therapy for over 4 years (since the study opened). We do not have the final analysis as to how many months patients have been on Revlimid (lenalidomide)."
Regarding your question about the duration of Revlimid maintenance: We asked Dr. Philip McCarthy of the Roswell Park Cancer Institute about the duration of maintenance in the CALGB study, which he is leading. He said:
"On CALGB 100104: patients remained on maintenance therapy indefinitely until disease progression or intolerance to therapy. This study was a single autotransplant followed by maintenance therapy starting at day 100 after transplant. There are patients who have remained on maintenance therapy for over 4 years (since the study opened). We do not have the final analysis as to how many months patients have been on Revlimid (lenalidomide)."
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