--a friend helped me translate this post, english is not my first language--
After reaching remission with a 30% reduction of monoclonal component, we have reached a still point, with a slight increase of the monoclonal peak, even though the fact that we missed a week of Revlimid in cycle 2 and one in cycle 3, caused by neutropenia, and one dose of Dexamethasone for high PCR levels caused by gastroenteritis could have had an effect on the response, doctors think a clone of plasmacells is being selected, as FISH showed chromosomal abnormalities 1q and t414 (the initial cytogenetic test showed no abnormalitites).
Should the situation not improve, medical staff have advised us to interrupt the therapy. We are currently waiting for the results from the centralized analysis for the end of the 3rd cycle because my mother is on the control arms of ELOQUENT 1
They propose an autologous transplant with PAD induction therapy and melphalan 140mg. Should my mother not want to undergo the transplant, I have been advised it is not allowed to administer VMP as a second line, just Velcade + dexamethasone
Hemoglobin is slightly decreasing, it's now at 9.6.
She has no further comorbidities (no renal failure, no heart disease and no bone lytic lesions), except osteoporosis and thyroid dysfunction, both of which she has had for several years, and she is in good conditions.
I would like to hear your comments on the proposed line of action, and any possible alternatives you may advise, and what your thoughts are, in case of transplant, of PAD induction, as other hospitals use VTD.
thank you in advance for your support
Forums
Re: Revlimid-dexamethasone no longer working
Hello Manuel,
I'm sorry to hear that your mother's treatment may no longer be working.
Given that your mother is taking part in the ELOQUENT trial, I am assuming that the Revlimid-dexamethasone treatment she has been receiving is her first treatment for myeloma. (The ELOQUENT trial, if I am not mistaken, is for newly diagnosed patients.)
So her first treatment regimen appears to be failing, and she has 1q and t4,14 chromosomal abnormalities. From an earlier post you made, your mother is about 70 or 71, and I believe you are in Italy.
Options being considered as a next step include:
- Velcade-doxorubicin-dex (PAD), followed by a transplant
- Velcade-thalidomide-dex (VTD), followed by a transplant
- Velcade-melphalan-prednisone (VMP), followed by a transplant
- Velcade-dexamethasone, without a transplant
Is anything missing from this list.
Personally, and admitting that I'm not a doctor, I would think that the first option (PAD+transplant) might be best for your mother.
Since she is failing on Rev-dex, the thalidomide in the VTD combination is not likely to do her as much good as if she were a newly diagnosed patient getting that treatment. Also, by avoiding thalidomide now, it may be more active for her should she relapse sometime in the future. Plus, PAD gives you a different agent in the induction therapy (doxorubicin) compared to the melphalan in the pre-transplant therapy. And dexamethasone is, I believe, viewed to be a more effective steroid for treating myeloma compared to prednisone.
Also, if your mother is physically able to do a transplant, I think now will be the time to do it. She will be less able to do it in the future.
One question: Is maintenance therapy after the transplant being discussed? Maintenance Velcade might be worth considering.
Also, be sure to see if your mother can get subcutaneous Velcade.
I hope this helps. Good luck!
I'm sorry to hear that your mother's treatment may no longer be working.
Given that your mother is taking part in the ELOQUENT trial, I am assuming that the Revlimid-dexamethasone treatment she has been receiving is her first treatment for myeloma. (The ELOQUENT trial, if I am not mistaken, is for newly diagnosed patients.)
So her first treatment regimen appears to be failing, and she has 1q and t4,14 chromosomal abnormalities. From an earlier post you made, your mother is about 70 or 71, and I believe you are in Italy.
Options being considered as a next step include:
- Velcade-doxorubicin-dex (PAD), followed by a transplant
- Velcade-thalidomide-dex (VTD), followed by a transplant
- Velcade-melphalan-prednisone (VMP), followed by a transplant
- Velcade-dexamethasone, without a transplant
Is anything missing from this list.
Personally, and admitting that I'm not a doctor, I would think that the first option (PAD+transplant) might be best for your mother.
Since she is failing on Rev-dex, the thalidomide in the VTD combination is not likely to do her as much good as if she were a newly diagnosed patient getting that treatment. Also, by avoiding thalidomide now, it may be more active for her should she relapse sometime in the future. Plus, PAD gives you a different agent in the induction therapy (doxorubicin) compared to the melphalan in the pre-transplant therapy. And dexamethasone is, I believe, viewed to be a more effective steroid for treating myeloma compared to prednisone.
Also, if your mother is physically able to do a transplant, I think now will be the time to do it. She will be less able to do it in the future.
One question: Is maintenance therapy after the transplant being discussed? Maintenance Velcade might be worth considering.
Also, be sure to see if your mother can get subcutaneous Velcade.
I hope this helps. Good luck!
Re: Revlimid-dexamethasone no longer working
Thank you very much for your reply Ricardo yes i'm from italy an my mother is 70' years's old
Sorry I haven't replied in a while, but I've been in hospital for the past 20 days due to complications this was the bad days of my life.
My mother suffered an intestinal stroke, caused by occlusion, and underwent removal surgery. They removed approx 70cm.
(Many years ago she had a Cholecystectomy)
Could this have been caused by the Rev-Dex treatment?
Today she had a 2-unit blood transfusion, because her hemoglobin was 8.4
We haven't discussed any maintenance therapy with the doctors yet.
At 70 years of age, is an allogenic transplant out of the question? Is the GVHD risk too high?
i read with non-mieloablative transplant is possible to do this treatment
in the old people too
Sorry I haven't replied in a while, but I've been in hospital for the past 20 days due to complications this was the bad days of my life.
My mother suffered an intestinal stroke, caused by occlusion, and underwent removal surgery. They removed approx 70cm.
(Many years ago she had a Cholecystectomy)
Could this have been caused by the Rev-Dex treatment?
Today she had a 2-unit blood transfusion, because her hemoglobin was 8.4
We haven't discussed any maintenance therapy with the doctors yet.
At 70 years of age, is an allogenic transplant out of the question? Is the GVHD risk too high?
i read with non-mieloablative transplant is possible to do this treatment
in the old people too
Re: Revlimid-dexamethasone no longer working
Dear Manuel,
I am sorry to hear that your Mother is not doing well. I wish her a speedy recovery from this recent setback.
I agree that a proteasome inhibitor-based approach to treatment is the right thing to do. Given the supoptimal response to lenalidomide (Revlimid)-based therapy, thalidomide is likely not going to have good activity under the circumstances. PAD followed by the melphalan treatment would be a very reasonable option, provided she is in good enough shape to handle this approach. In the US, CyBorD (cyclophosphamide, Velcade, dexamethasone) is often used as is RVD (Revlimid, Velcade, dexamethasone). The latter would be considered based on the premise that the Revlimid would work better in the context of Velcade than by itself (synergy between the 2 drugs). I think the PAD or CyBorD approach would be good options. If this intestinal complication has made your mother very ill, to the point that she would not tolerate a multi-drug combination, a Velcade and dexamethasone regimen may be necessary, at least in the short term.
Good luck and hang in there!
Pete V.
I am sorry to hear that your Mother is not doing well. I wish her a speedy recovery from this recent setback.
I agree that a proteasome inhibitor-based approach to treatment is the right thing to do. Given the supoptimal response to lenalidomide (Revlimid)-based therapy, thalidomide is likely not going to have good activity under the circumstances. PAD followed by the melphalan treatment would be a very reasonable option, provided she is in good enough shape to handle this approach. In the US, CyBorD (cyclophosphamide, Velcade, dexamethasone) is often used as is RVD (Revlimid, Velcade, dexamethasone). The latter would be considered based on the premise that the Revlimid would work better in the context of Velcade than by itself (synergy between the 2 drugs). I think the PAD or CyBorD approach would be good options. If this intestinal complication has made your mother very ill, to the point that she would not tolerate a multi-drug combination, a Velcade and dexamethasone regimen may be necessary, at least in the short term.
Good luck and hang in there!
Pete V.
-
Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Revlimid-dexamethasone no longer working
this time not helped by my friend in translation hope you understand anyway
thank you for your empathy doctor Peter Voorhes,
my mother is ok now,not like before the surgery but i think she can tolerate the treatment
(the hematologists say she can)
we have an appointment nexth week for the blood count to check if is ok
RVD i think is not an option in italy ......
in this phrase you said :The latter would be considered based on the premise that the Revlimid would work better in the context of Velcade than by itself (synergy between the 2 drugs)
this thing is true even with Thalidomide in the VTD regimen?
what's the more efficent between this three regimen VTD,PAD and CyBorD
i have fear of peripheral neuropathy in VTD because there is two drugs that can lead to this side effects and i fear too the doxorubicin for the heart damage i know my mother have to faces
with this possibly side effects but i'm scared
MOST IMPORTANT QUESTION : there is a scientific method that can lead to specific regimen?
the induction of this three scheme is the same except one drugs right?
for example : we now in the case of my mother with cytogenetics abnormalities Velcade based regimen is the best option
there is a factor that can predict if doxorubicine in PAD,thalidomide in VTD or cyclophosphamide in CybOrD is the best one?
i hope my question is understandable and thanks all of you
thank you for your empathy doctor Peter Voorhes,
my mother is ok now,not like before the surgery but i think she can tolerate the treatment
(the hematologists say she can)
we have an appointment nexth week for the blood count to check if is ok
RVD i think is not an option in italy ......
in this phrase you said :The latter would be considered based on the premise that the Revlimid would work better in the context of Velcade than by itself (synergy between the 2 drugs)
this thing is true even with Thalidomide in the VTD regimen?
what's the more efficent between this three regimen VTD,PAD and CyBorD
i have fear of peripheral neuropathy in VTD because there is two drugs that can lead to this side effects and i fear too the doxorubicin for the heart damage i know my mother have to faces
with this possibly side effects but i'm scared
MOST IMPORTANT QUESTION : there is a scientific method that can lead to specific regimen?
the induction of this three scheme is the same except one drugs right?
for example : we now in the case of my mother with cytogenetics abnormalities Velcade based regimen is the best option
there is a factor that can predict if doxorubicine in PAD,thalidomide in VTD or cyclophosphamide in CybOrD is the best one?
i hope my question is understandable and thanks all of you
Re: Revlimid-dexamethasone no longer working
I have not been impressed with the activity of thalidomide in cases of Revlimid resistance. I think the CyBorD or PAD regimens would be the better options.
Best of luck!
Pete V.
Best of luck!
Pete V.
-
Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: Revlimid-dexamethasone no longer working
Ricardo wrote:
> One question: Is maintenance therapy after the transplant being discussed?
> Maintenance Velcade might be worth considering.
>
> Also, be sure to see if your mother can get subcutaneous Velcade.
>
> I hope this helps. Good luck!
i'm lost this thing in your post.......
no i didn't discussed for manteinance theraphy after transplant but one doctor,not the one who take care of my mother says the same thing you tell me about Velcade,but
for what i know Velcade is not allowed in italy as a manteinance therapy only thalidomide for manteinance outside clinical trials,
i want to have a better vision about the permission of subministrate Velcade manteinance regimen in my country
fortunally subcutaneous Velcade is now allowed in italy but is only 3/4 months
this evening i see another one head physician agreed on the PAD induction regimen but
tell me bad things that i never want to hear he says:
i don't have to focalize on the ASCT first we have to see if the PAD work and how deeper responce my mother reach,then we can think if my mother can undergo the ASCT
and evene if the transplant doing wheel
for my mother with that cytogenetics (1q,T414)
the median duration of remission
is ONLY 12/18 months after transplant.......
is only one year and half i'm very sad.........i hope new efficent drugs is avaiable in short time
> One question: Is maintenance therapy after the transplant being discussed?
> Maintenance Velcade might be worth considering.
>
> Also, be sure to see if your mother can get subcutaneous Velcade.
>
> I hope this helps. Good luck!
i'm lost this thing in your post.......
no i didn't discussed for manteinance theraphy after transplant but one doctor,not the one who take care of my mother says the same thing you tell me about Velcade,but
for what i know Velcade is not allowed in italy as a manteinance therapy only thalidomide for manteinance outside clinical trials,
i want to have a better vision about the permission of subministrate Velcade manteinance regimen in my country
fortunally subcutaneous Velcade is now allowed in italy but is only 3/4 months
this evening i see another one head physician agreed on the PAD induction regimen but
tell me bad things that i never want to hear he says:
i don't have to focalize on the ASCT first we have to see if the PAD work and how deeper responce my mother reach,then we can think if my mother can undergo the ASCT
and evene if the transplant doing wheel
for my mother with that cytogenetics (1q,T414)
the median duration of remission
is ONLY 12/18 months after transplant.......
is only one year and half i'm very sad.........i hope new efficent drugs is avaiable in short time
Re: Revlimid-dexamethasone no longer working
There is a Dr Palumbo in Torino I believe who is a known multiple myeloma specialist, someone who lives in bergamo, she had sct and then Revlimid for maintenance, do more research, get more options, there are also numerous trials. Do not give up. Good luck and prayers, Maria
-
Maria
Re: Revlimid-dexamethasone no longer working
thank you for your support Maria,
bergamo is near by me i think is 40 miles but Revlimid didn't work on my mother
i'll try to find trial of Velcade maintenance if is well tollereated in the induction phase
tomorrow have another appointment with another doctor i don't give up thank you
bergamo is near by me i think is 40 miles but Revlimid didn't work on my mother
i'll try to find trial of Velcade maintenance if is well tollereated in the induction phase
tomorrow have another appointment with another doctor i don't give up thank you
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