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Discussion about multiple myeloma treatments, stem cell transplants, clinical trials, alternative medicines, supplements, and their benefits and side effects.

Revlimid - fatigue, weight loss, anemia & low platelets

by richardclayton53 on Tue Sep 23, 2014 7:17 am

Hi everyone,

I really am not sure where to start, so perhaps a little background info might help!

My mum was diagnosed with multiple myeloma late last August, and it's been a nightmare roller coaster ever since. I have nothing but respect and sympathy for anyone going through what we are.

Mum had a stem cell transplant (SCT) at the start of January this year, but by March had a phone call from the hospital saying it hadn't worked. This crushed us, as obviously we had all pinned our hopes on this giving her a time of feeling as well as can be expected.

I think it was in April that she was put on to lenalidomide (Revlimid) and some steroids (I think must be dexamethasone).

Anyway, this has worked pretty well, bringing all of her results back to a normal (ish) level, so the consultant said this was a long term fix.

However, lately (last 3 weeks, I guess) she has gone rapidly down hill to the point where she cannot get out of bed most mornings without help. She is weak, lethargic, no energy and has lost no end of weight. She said she feels 'sedated' most of the time, and we are getting worried.

She is due to see her consultant a week from today. She was called in Saturday because she was anaemic and her platelets had dropped from the 180 mark down to 39. She had two lots of blood and one lot of platelets, and was expected to pick up, but today it is just as bad.

Also she keeps getting lots of blood blisters in her mouth and on her tongue and even on her fingers.

She is on 10 mg per day of Revlimid.

I guess what I am asking is, has anyone else experienced these kind of symptoms and extreme lethargy? Could it be that her dose of Revlimid is too high? I read somewhere that it is a sedative drug.

I know we will find out more next week, but the family are at our wits end :(

Hoping anyone can help shed some light on things, or have been through similar.

Thank you all for reading.

Richard x

richardclayton53
Name: Richard Clayton
Who do you know with myeloma?: Mum
When were you/they diagnosed?: 31 August 2013
Age at diagnosis: 63

Re: Revlimid - fatigue, weight loss, anemia & low platelets

by NStewart on Wed Sep 24, 2014 2:21 pm

Richard-
Has your mother called her oncologist to report her symptoms since the blood transfusions? It sounds like she shouldn't wait until next week to see her doctor.

In May this year while I was on vacation in Europe I was experiencing fatigue and loss of energy. Of course I attributed it to the fact that I was traveling and doing a lot more walking, etc than usual. I had been to see my oncologist right before I left for vacation and all of my blood test results were good. When I returned from Europe and had my regularly scheduled oncology appointment the beginning of June, my blood levels had dropped dramatically. Thus, the explanation for the fatigue, etc. I was taking Revlimid 15 mg.

My doctor took me off of the Revlimid for 4 weeks to see if my blood levels would recover. By my next visit everything had returned to normal levels. My doctor put me back on Revlimid at that point, but at 10 mg. The lower dose is working well for me.

Your mother may need a lower dose of Revlimid than the 10 mg. Or, she may need a change in her treatment regimen. I would suggest that you encourage your mother to call her doctor if she hasn't already. She shouldn't let her current symptoms continue for another week without the doctor knowing how bad she is feeling.

Let us know what heppens and the best to your mother,
Nancy in Phila

NStewart
Name: Nancy Stewart
Who do you know with myeloma?: self
When were you/they diagnosed?: 3/08
Age at diagnosis: 60

Re: Revlimid - fatigue, weight loss, anemia & low platelets

by Cheryl G on Wed Sep 24, 2014 5:38 pm

Hi Richard,

Sorry to hear about what your mother is going through. I hope her condition has improved a bit since you posted.

As Nancy suggested in her posting, Revlimid may very well be the cause of the fatigue and other issues she is having. You'll often see people here in the forum complain about fatigue from Revlimid. Also, Revlimid, like just about all myeloma drugs, has a tendency to lower blood cell counts. This is true for red blood cell and platelet counts, but also true for white blood cell counts.

I think the blood blisters you mentioned are probably related to your mother's low platelet counts as well: "low platelet counts ... can cause red or purple dots on the skin, called petechiae, and problems with easy bruising, nosebleeds, blood blisters in the mouth or internal bleeding."

http://www.ucsfhealth.org/conditions/immune_thrombocytopenia/

Also, in cancer patients, anemia such as what your mother's can cause weight loss: "Symptoms of the conditions that cause ... anemia include ... Weight loss (in people with cancer)"

http://www.nlm.nih.gov/medlineplus/ency/article/000584.htm

Has your mother had any recent tests of her main myeloma-related markers, such as her M-spike (paraprotein, m-protein) and free light chain levels and ratio? Although the Revlimid could be the cause of the symptoms she's experiencing, it would be a good idea to make certain that there is nothing going on with her myeloma that also could be causing the symptoms.

Good luck, and please let us know if we can answer any more questions and keep us updated on your mother's situation.

Cheryl G

Re: Revlimid - fatigue, weight loss, anemia & low platelets

by Dr. Ken Shain on Thu Sep 25, 2014 11:12 am

Revlimid is a great drug for myeloma patients, but as you are learning it can have pretty significant side effects.

Fatigue and marrow suppression (decreased white cells, Hgb, and platelets) are quite common. Anorexia, nausea, diarrhea, and abdominal cramps/discomfort are somewhat less frequent, but not uncommon. For the most part, dose reductions can improve the symptoms. However in some patients, alternate treatment strategies are necessary because of the severity of the side effects.

I would have your mother give her oncologist a call for a visit and labs at least with a PA to make sure that she remains in a safe range and does not need a transfusion of blood, platelets and/or holding the medication.

Please keep us updated. I we wish your mom the best.

Dr. Ken Shain
Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor


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