[rhondas]

Problems with both Revlimid & Velcade - what to do?

by rhondas on Sat Jul 05, 2014 4:43 pm

My father was diagnosed in April of this year. Started on Revlimid and ended up in renal failure and dialysis started. Revlimid was stopped, and his kidneys recovered (thankfully).

He was then started on Velcade. After his first injection he had spontaneous bleeding and was hospitalized to receive transfusions. The doctor gave him a 3 week break from treatment to recover and this past Thursday the doctor drew labs and, before they were all back, they gave him another injection of Velcade. We received a phone call that his liver enzymes are extremely elevated.

My questions are:

What now? Do we have to stop treatment? I can't imagine that the chemo is not going to further damage his liver.

It seems that his myeloma is aggressive, but every treatment they give him causes some kind of catastrophic body failure.

I should also state that since April he has lost over 40 pounds and now weighs 143. I just don't know how to advise him and would like some advice.

Thanks in advance!

[Dr. Ken Shain]

Re: Problems with both Revlimid & Velcade - what to do?

by Dr. Ken Shain on Sun Jul 06, 2014 10:39 am

Depending on age and overall health there are a number of options at this point. That being said, it sounds like a very difficult situation -- and fraught with a lot anxiety.

It also seems a bit atypical, to say the least. Both drugs are generally very well tolerated. Revlimid itself is generally not toxic to the kidneys. It is cleared by the kidneys, but generally isn't toxic to them.

Depending on the extent of the transaminitis (elevated liver enzymes) you are seeing, Velcade dose reductions could be tried. So retry Velcade at a lower dose or schedule (weekly instead of twice weekly).

Importantly, there are other drugs that can be used in myeloma - Kyprolis (carfilzomib) (a pro­tea­some inhibitor, like Velcade), thalidomide and Pomalyst (pomalidomide) (both immuno­modu­la­tory agents, like Revlimid, but with different renal toxicity profiles).

There are also more typical chemotherapeutics that can be utilized (cyclophosphamide [Cytoxan], Doxil, melphalan) in combination.

Please keep us updated.

[rhondas]

Re: Problems with both Revlimid & Velcade - what to do?

by rhondas on Sun Jul 06, 2014 1:44 pm

Thank you for your reply! His Velcade dosage at this point is only once weekly. He has never received Velcade more than that. I believe it was started that way due to his intolerance to the Revlimid. His overall health at this point isn't very good in part due to his extreme weight loss.

Before diagnosis he was seen by 2 hospitals and his PCP and all diagnosed him with a lower back strain. So by the time I got him to a larger hospital and he was properly diagnosed, his back was fractured in 5 places and he was very, very ill. He has never properly recovered from that.

His ALT & AST are quadrupled. AP is 6 times normal. And he is starting to look jaundiced.
I guess what I am worried about is that if we keep treating the myeloma, his liver isn't going to tolerate it much longer. And we all know the outcome if we don't treat the myeloma ...