Hi all,
On September 1st this year I started on Revlimid 15 mg (21 days on, 7 off) and 20 mg dexamethasone to lower my lambda light chains. I do not have an M-spike. I have light chain multiple myeloma.
Anyway, my appointment at the end of my 1st cycle my light chains dropped from 1139 to 790. I was happy that it has worked while I put up with the usual side effects. After my second cycle appointment my light chains went up to 924. We are going to try one more cycle and see what happens.
Is this sort of result common after the second cycle?
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Re: Discouraged after 2nd cycle of Revlimid & dexamethasone
Hi restlessrebel,
I am slightly confused by your treatment.
Is this your induction therapy or maintenance?
My husband also has light chain myeloma.
Our induction therapy consisted of 25 mg Revlimid x 21 days, 2 shots of Velcade per week, and dexamethesone 2 days a week.. We did all of this for 3 weeks then a week off. This consisted of 1 cycle and we did a total of 6 cycles.
His light chains went to normal after 2 cycles.
Is there a reason you're not on higher dose of Revlimid along with Velcade?
Are you seeing a myeloma specialist?
Do you have kidney issues that prevent other medications?
Kerri
I am slightly confused by your treatment.
Is this your induction therapy or maintenance?
My husband also has light chain myeloma.
Our induction therapy consisted of 25 mg Revlimid x 21 days, 2 shots of Velcade per week, and dexamethesone 2 days a week.. We did all of this for 3 weeks then a week off. This consisted of 1 cycle and we did a total of 6 cycles.
His light chains went to normal after 2 cycles.
Is there a reason you're not on higher dose of Revlimid along with Velcade?
Are you seeing a myeloma specialist?
Do you have kidney issues that prevent other medications?
Kerri
Re: Discouraged after 2nd cycle of Revlimid & dexamethasone
Hi Kerri,
I am seeing a myeloma specialist and we agreed on the lower induction doses, as there have been studies showing that the lower doses are effective as well. He can't raise mine because my white cells and potassium are increasing after the second cycle. I think he is going to add Velcade to my regimen. Did you have many side effects from the Velcade, Kerri?
I am seeing a myeloma specialist and we agreed on the lower induction doses, as there have been studies showing that the lower doses are effective as well. He can't raise mine because my white cells and potassium are increasing after the second cycle. I think he is going to add Velcade to my regimen. Did you have many side effects from the Velcade, Kerri?
Re: Discouraged after 2nd cycle of Revlimid & dexamethasone
Hi restlessrebel,
We had Velcade as a subcutaneous injection in the abdomen twice a week. My husband had redness at the injection site that was large and patchy. If the nurse uses the bubble technique, the redness was much less.
The bubble technique adds a little air in the syringe so when shot is given the air is the last thing that enters the body and pushed the medication deeper into the tissue and away from the surface which decreased redness. The nurses were very receptive to this technique.
My husband also experience peripheral neuropathy after cycle 3 that got progressively worse with subsequent cycles. This consisted of foot pain, needle like stabbing and aching. He started on Cymbalta (duloxetine) 20 mg daily, which removed the neuropathy almost instantly.
I hope that adding the Velcade brings your numbers down with minimal side effects. I am glad you are seeing a specialist!
Kerri
We had Velcade as a subcutaneous injection in the abdomen twice a week. My husband had redness at the injection site that was large and patchy. If the nurse uses the bubble technique, the redness was much less.
The bubble technique adds a little air in the syringe so when shot is given the air is the last thing that enters the body and pushed the medication deeper into the tissue and away from the surface which decreased redness. The nurses were very receptive to this technique.
My husband also experience peripheral neuropathy after cycle 3 that got progressively worse with subsequent cycles. This consisted of foot pain, needle like stabbing and aching. He started on Cymbalta (duloxetine) 20 mg daily, which removed the neuropathy almost instantly.
I hope that adding the Velcade brings your numbers down with minimal side effects. I am glad you are seeing a specialist!
Kerri
Re: Discouraged after 2nd cycle of Revlimid & dexamethasone
Hello restlessrebel,
I have the IgG kappa light chain multiple myeloma and I, too, do not have any measurable M-Spike. Kerri has already covered the major side effect of the Velcade shots. The only other advice (thanks mikeb) I had received during my 8 or so induction phase cycles was that Velcade shots can make you drowsy and to make sure you take your dex in the morning, before the Velcade shot in the afternoon. I was already taking the dex on the morning of my Velcade shot.
The main side effect (besides the Velcade rash) I experienced was the fatigue, which got worse with every cycle. Initially I had the 1-day high after the dex-Velcade, followed by a 1-day fatigue. The weekly fatigue seemed to last for 3 or 4 days as I neared the end of my 7th or 8th cycle. It took almost 3 months after the Velcade was stopped to get back to the weekly 1-day fatigue, while I was taking dex.
I am only on an alternate day 15 mg Revlimid for maintenance now and I get about a 4-hour muscle soreness and fatigue in the afternoon on the day after I take my Revlimid. Therefore, the Revlimid must have been contributing to the fatigue during the induction phase.
My Revlimid and dex dosing was identical to yours, except I had the Velcade shots every week during the induction. I had understood that the Revlimid-dex is usually for maintenance and I had that for about 4 cycles before my oncologist stopped the dex to avoid the long-term side effects of dex.
The only other relevant experience I had was that my kappa came down rapidly to 24 from 1,070 in 4 cycles but rose back up to 48 when I had a flu. It took another cycle to bring the kappa down to the 24 level (my induction phase had a net 2-cycle delay). My understanding is that the immune system reacts to these infections and the the IgG kappa and lambda chains rise during the immune response. This may or may not apply in your case.
I hope you see dramatic drop in your lambda readings with the addition of the weekly Velcade (RVD therapy).
I have the IgG kappa light chain multiple myeloma and I, too, do not have any measurable M-Spike. Kerri has already covered the major side effect of the Velcade shots. The only other advice (thanks mikeb) I had received during my 8 or so induction phase cycles was that Velcade shots can make you drowsy and to make sure you take your dex in the morning, before the Velcade shot in the afternoon. I was already taking the dex on the morning of my Velcade shot.
The main side effect (besides the Velcade rash) I experienced was the fatigue, which got worse with every cycle. Initially I had the 1-day high after the dex-Velcade, followed by a 1-day fatigue. The weekly fatigue seemed to last for 3 or 4 days as I neared the end of my 7th or 8th cycle. It took almost 3 months after the Velcade was stopped to get back to the weekly 1-day fatigue, while I was taking dex.
I am only on an alternate day 15 mg Revlimid for maintenance now and I get about a 4-hour muscle soreness and fatigue in the afternoon on the day after I take my Revlimid. Therefore, the Revlimid must have been contributing to the fatigue during the induction phase.
My Revlimid and dex dosing was identical to yours, except I had the Velcade shots every week during the induction. I had understood that the Revlimid-dex is usually for maintenance and I had that for about 4 cycles before my oncologist stopped the dex to avoid the long-term side effects of dex.
The only other relevant experience I had was that my kappa came down rapidly to 24 from 1,070 in 4 cycles but rose back up to 48 when I had a flu. It took another cycle to bring the kappa down to the 24 level (my induction phase had a net 2-cycle delay). My understanding is that the immune system reacts to these infections and the the IgG kappa and lambda chains rise during the immune response. This may or may not apply in your case.
I hope you see dramatic drop in your lambda readings with the addition of the weekly Velcade (RVD therapy).
-
K_Shash - Name: K_Shash
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: November 2014
- Age at diagnosis: 67
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