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Infections with Revlimid
My dad has been using Revlimid for a while and almost always gets a lung infection every cycle. Can anyone share some suggestions/experience? Thanks.
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peterzl
Re: Infections with Revlimid
Hello,
I am no expert and I am very new to this. But did your husband's doctor prescribe antibiotics to take in combination with the Revlimid? My mom takes Bactrim (sulfamethoxazole and trimethoprim) and famciclovir (Famvir) daily for infection control.
I am no expert and I am very new to this. But did your husband's doctor prescribe antibiotics to take in combination with the Revlimid? My mom takes Bactrim (sulfamethoxazole and trimethoprim) and famciclovir (Famvir) daily for infection control.
Re: Infections with Revlimid
Peterzl,
Some articles to consider:
"Preventative Antibiotics May Not Decrease Infections In Myeloma Patients Undergoing Initial Treatment," The Myeloma Beacon, July 18, 2012.
“Unfortunately, prophylactic antibiotics did not significantly decrease the risk of infection,” said Dr. David Vesole from the John Theurer Cancer Center and lead investigator of the study. “This was an unexpected finding.” Dr. Vesole indicated that perhaps different antibiotics would lower the infection rate"
"HOWEVER, they acknowledged that patients who are considered high-risk for developing bacterial infections may benefit from prophylactic antibiotics. These include patients with a history of repeated infections or severely low immunoglobulin levels, and patients receiving more intense treatment regimens."
Also:
D Reece et al, "Practical Approaches to the Use of Lenalidomide in Multiple Myeloma: A Canadian Consensus," Advances in Hematology, 2012 (full text)
"Despite the immunomodulatory effect of lenalidomide, the infection rate was increased with the addition of lenalidomide in both the MM-009 and MM-010 trials [12, 13]. Most infections were low-grade, with grade 3-4 infections seen in 10–20% of patients. Per study protocol, no antibiotic prophylaxis was provided in either of the two phase III trials. Due to this risk of infection, antibiotic prophylaxis may be considered for patients treated with Len/Dex, especially if HD dexamethasone is used. Unfortunately, there currently exists no recommendation for a single antibiotic class for this purpose, but our own preference is levofloxacin. Given that use of LD dexamethasone is associated with less frequent infections in newly diagnosed patients [30], it is not clear whether routine antibiotic prophylaxis is necessary"
And:
DM Weber et al, "Lenalidomide plus Dexamethasone for Relapsed Multiple Myeloma in North America," New England Journal of Medicine, Nov 22, 2007 (full text)
"In our study, grade 3 or 4 infections were noted in 21.5% of patients treated with lenalidomide, so future study of treatment or prophylaxis with granulocyte colony-stimulating factor, prophylaxis with oral broad-spectrum bacterial antibiotics, or both may be warranted"
Some articles to consider:
"Preventative Antibiotics May Not Decrease Infections In Myeloma Patients Undergoing Initial Treatment," The Myeloma Beacon, July 18, 2012.
“Unfortunately, prophylactic antibiotics did not significantly decrease the risk of infection,” said Dr. David Vesole from the John Theurer Cancer Center and lead investigator of the study. “This was an unexpected finding.” Dr. Vesole indicated that perhaps different antibiotics would lower the infection rate"
"HOWEVER, they acknowledged that patients who are considered high-risk for developing bacterial infections may benefit from prophylactic antibiotics. These include patients with a history of repeated infections or severely low immunoglobulin levels, and patients receiving more intense treatment regimens."
Also:
D Reece et al, "Practical Approaches to the Use of Lenalidomide in Multiple Myeloma: A Canadian Consensus," Advances in Hematology, 2012 (full text)
"Despite the immunomodulatory effect of lenalidomide, the infection rate was increased with the addition of lenalidomide in both the MM-009 and MM-010 trials [12, 13]. Most infections were low-grade, with grade 3-4 infections seen in 10–20% of patients. Per study protocol, no antibiotic prophylaxis was provided in either of the two phase III trials. Due to this risk of infection, antibiotic prophylaxis may be considered for patients treated with Len/Dex, especially if HD dexamethasone is used. Unfortunately, there currently exists no recommendation for a single antibiotic class for this purpose, but our own preference is levofloxacin. Given that use of LD dexamethasone is associated with less frequent infections in newly diagnosed patients [30], it is not clear whether routine antibiotic prophylaxis is necessary"
And:
DM Weber et al, "Lenalidomide plus Dexamethasone for Relapsed Multiple Myeloma in North America," New England Journal of Medicine, Nov 22, 2007 (full text)
"In our study, grade 3 or 4 infections were noted in 21.5% of patients treated with lenalidomide, so future study of treatment or prophylaxis with granulocyte colony-stimulating factor, prophylaxis with oral broad-spectrum bacterial antibiotics, or both may be warranted"
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Infections with Revlimid
Hi Peter,
Are your dad's infections caused by bacteria or viruses? I had lots of viral infections while on Revlimid, so my doctor prescribed antivirals. After that, I had no infections at all.
Of course, if the infections are bacterial, antivirals will not help.
Are your dad's infections caused by bacteria or viruses? I had lots of viral infections while on Revlimid, so my doctor prescribed antivirals. After that, I had no infections at all.
Of course, if the infections are bacterial, antivirals will not help.
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finn
Re: Infections with Revlimid
Thanks go to everyone for sharing. The doctor said it was bacteria and prophylactic antibiotics seemed to be the only choice next time. Unfortunately patients with multiple myeloma always get infections easily, that was what the doctors said.
For my dad it was even more complicated because of his age, diabetes and hypertension. The doctor prescribed melphalan + prednisone + thalidomide for the first few cycles, and due to the neuropathy caused by thalidomide, he is now taking lenalidomide instead, which seems to be causing infection.
Again, many thanks for all your support.
For my dad it was even more complicated because of his age, diabetes and hypertension. The doctor prescribed melphalan + prednisone + thalidomide for the first few cycles, and due to the neuropathy caused by thalidomide, he is now taking lenalidomide instead, which seems to be causing infection.
Again, many thanks for all your support.
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peterzl
Re: Infections with Revlimid
As I have a trach, I and my doc believe I am at a more heightened risk for infection. We found I was apparently allergic to Bactrim (sulfamethoxazole and trimethoprim), and was switched to dapsone (treatment of choice for leprosy as well), and an antiviral acyclovir. I find myself a little foggier than usual, and some fine motor deficits, but very tolerable.
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GLCarlton - Name: GLC
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: June 2014
- Age at diagnosis: 62
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