Hi Everyone,
My father who is 68 years old has been recently diagnosed with multiple myeloma, IgA lambda type, and is currently on treatment for the past two months.
At the time of diagnosis, his hemoglobin level was 4.8 and after subsequent treatments (two units of blood transfusion and erythropoietin injections weekly) his level came to 7.6 and currently it's 8.0.
He is currently taking dexamethasone 40 mg IV infusion), bortezomib (Velcade) 2 mg subcutaneous day 1,3,10,13, and a lenalidomide (Revlimid) capsule 10 mg everyday each month.
His renal parameters are normal.
The doctor who treats my father suggested that my father could go for an autologous stem cell transplant after completing 6 cycles if all other parameters look good.
A couple of days back, I had a consultation with another doctor who treats multiple myeloma to get the second opinion on the prognosis of the treatment and getting my father ready for a stem cell transplant. After looking at the reports, the doctor said he would not suggest my father go for Revlimid everyday each month if the patient is getting ready for a stem cell transplant, and also that my father could go for transplant after completing 4 cycles instead of 6.
Would like to get some opinions about the medicines he is currently taking during each cycle of the treatment before his stem cell transplant. Should my father take some other medicine equivalent to Revlimid?
I will also check with the doctor who currently treats my father before requesting any change in the treatment course.
Thanks.
Forums
Re: Revlimid prior to stem cell transplant - is it okay?
Good morning.
My husband's initial treatment prior to his stem cell transplant was Revlimid (25 mg), Velcade, and dexamethasone. I'm sorry, but I can't remember the dosage of dex. Each four-week cycle, he took Revlimid every day for three weeks, and then had one week off. He did 4 cycles of this regimen and was then treatment free for 6 weeks before transplant.
He was diagnosed at stage 3.
Hope this helps, and best wishes to your dad and your family.
My husband's initial treatment prior to his stem cell transplant was Revlimid (25 mg), Velcade, and dexamethasone. I'm sorry, but I can't remember the dosage of dex. Each four-week cycle, he took Revlimid every day for three weeks, and then had one week off. He did 4 cycles of this regimen and was then treatment free for 6 weeks before transplant.
He was diagnosed at stage 3.
Hope this helps, and best wishes to your dad and your family.
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reece93 - Name: reece93
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: October 2014
- Age at diagnosis: 57
Re: Revlimid prior to stem cell transplant - is it okay?
My husband also was on Velcade, dex, and Revlimid prior to transplant. After 4 cycles the Revlimid was stopped 6 weeks prior to transplant, similar to Reece93's response. He completed 6 cycles of Velcade but received that up until the week of his transplant.
Good luck to your father!
Good luck to your father!
Re: Revlimid prior to stem cell transplant - is it okay?
My husband who was 57 when he was diagnosed in February, 2016 with Stage 3 IgG lambda multiple myeloma. He had an M-spike of 5.6 g/dL
He was put on Velcade twice weekly for 3 weeks on 1 week off. He also received dex on Velcade days, and Revlimid 25 mg everyday for 3 weeks with the 4th week off. He was told he would be on this regimen for 4-6 months. The goal was to get the M-spike as low or gone as you can prior to transplant. He plateaued on his 5th cycle, they did a sixth cycle to see if the M-spike would move again, nothing, so off we went to transplant. He had to be off all treatment (Revlimid and Velcade) for 30 days before he could get Neupogen and then the stem cell harvest.
He had his transplant in August 2016. He still had a significant M-spike at his post transplant, 100-day check up. Had a port placed in December 2016 with Kyprolis infusions along with dex and Revlimid 25 mg everyday again for 3 weeks. (My husband is under the care of a myeloma specialist at Moffitt, by the way.)
Long story short, he had to be off all treatment for 30 days prior to transplant.
Each case is unique to the individual. Do not get discouraged. My husband's numbers stopped again after the second month of Kyprolis. M-spike did not go down, but it did not go up either. Low and behold, he went to maintenance after 4th cycle of Kyprolis for good measure, which is Revlimid 10 mg everyday now. His M-spike now is not enough to quantify.
He is now 59 and doing leaps and bounds better than he was this time last year.
Hope this helps. Stay the course, induction and unknown was the worst of it for us, and statistics are meant to be rewritten. Sending prayers for your dad and family.
He was put on Velcade twice weekly for 3 weeks on 1 week off. He also received dex on Velcade days, and Revlimid 25 mg everyday for 3 weeks with the 4th week off. He was told he would be on this regimen for 4-6 months. The goal was to get the M-spike as low or gone as you can prior to transplant. He plateaued on his 5th cycle, they did a sixth cycle to see if the M-spike would move again, nothing, so off we went to transplant. He had to be off all treatment (Revlimid and Velcade) for 30 days before he could get Neupogen and then the stem cell harvest.
He had his transplant in August 2016. He still had a significant M-spike at his post transplant, 100-day check up. Had a port placed in December 2016 with Kyprolis infusions along with dex and Revlimid 25 mg everyday again for 3 weeks. (My husband is under the care of a myeloma specialist at Moffitt, by the way.)
Long story short, he had to be off all treatment for 30 days prior to transplant.
Each case is unique to the individual. Do not get discouraged. My husband's numbers stopped again after the second month of Kyprolis. M-spike did not go down, but it did not go up either. Low and behold, he went to maintenance after 4th cycle of Kyprolis for good measure, which is Revlimid 10 mg everyday now. His M-spike now is not enough to quantify.
He is now 59 and doing leaps and bounds better than he was this time last year.
Hope this helps. Stay the course, induction and unknown was the worst of it for us, and statistics are meant to be rewritten. Sending prayers for your dad and family.
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DaleJC28117 - Name: Dale
- Who do you know with myeloma?: Husband
- When were you/they diagnosed?: 2016
- Age at diagnosis: 57
Re: Revlimid prior to stem cell transplant - is it okay?
Whether or not a patient is treated with Revlimid as part of their first treatment regimen for multiple myeloma depends on what country they live in, but it is certainly a common initial treatment in many countries. In the U.S., for example, I believe the Revlimid, Velcade, and dexamethasone (RVD) regimen is probably the most common initial therapy.
The length of RVD treatment prior to transplantation is, however, variable. It depends on things like doctor and treatment center preference and how the patient responds to treatment.
In your father's case, there may be concern about using Revlimid because the drug increases the chances that a patient will not be able to harvest enough stem cells for a stem cell transplant. This effect of Revlimid is less of a concern in parts of the world where access to Mozobil (plerixafor) is routine, since patients who have difficulty harvesting enough stem cells can be given Mozobil to increase the number of stem cells they can harvest. (Neupogen and cyclophosphamide are otherwise the most common stem cell mobilisation agents, and Mozobil is very expensive and may increase the risk of a secondary cancer.)
The reason there may be concern about your father's ability to harvest enough stem cells is, I believe, that his hemoglobin levels are suggesting that his bone marrow function is compromised. This is, however, just a guess on my part. His doctor really should explain the reason for wanting to avoid Revlimid.
Revlimid has two "cousins", thalidomide and Pomalyst (pomalidomide, Imnovid), that also are used to treat multiple myeloma. I believe the research suggests that thalidomide does not affect stem cell mobilisation and collection. I am not sure about Pomalyst.
Cheers!
The length of RVD treatment prior to transplantation is, however, variable. It depends on things like doctor and treatment center preference and how the patient responds to treatment.
In your father's case, there may be concern about using Revlimid because the drug increases the chances that a patient will not be able to harvest enough stem cells for a stem cell transplant. This effect of Revlimid is less of a concern in parts of the world where access to Mozobil (plerixafor) is routine, since patients who have difficulty harvesting enough stem cells can be given Mozobil to increase the number of stem cells they can harvest. (Neupogen and cyclophosphamide are otherwise the most common stem cell mobilisation agents, and Mozobil is very expensive and may increase the risk of a secondary cancer.)
The reason there may be concern about your father's ability to harvest enough stem cells is, I believe, that his hemoglobin levels are suggesting that his bone marrow function is compromised. This is, however, just a guess on my part. His doctor really should explain the reason for wanting to avoid Revlimid.
Revlimid has two "cousins", thalidomide and Pomalyst (pomalidomide, Imnovid), that also are used to treat multiple myeloma. I believe the research suggests that thalidomide does not affect stem cell mobilisation and collection. I am not sure about Pomalyst.
Cheers!
Re: Revlimid prior to stem cell transplant - is it okay?
My initial treatment was Revlimid 15 mg for 21 days and 7 days off and 40 mg of dexamethasone once a week. I had 8 cycles of this before preparing for transplant. I also had 6 weeks of no treatment before the transplant and 2 weeks of no treatment before preparing for harvest. My regimen for preparing for harvest was a Cytoxan infusion followed by 10 days of twice a day Neupogen injections. I had one day of harvesting to obtain enough cells for 2 transplants.
The reason for 8 cycles of treatment was so that the transplant could be scheduled at a time where my sister was available to come and stay with me for 6 weeks. i also didn't want to have it right before Thanksgiving to ruin my holidays. As it turned out, having the transplant the end of January in 2010 was good timing. We had 2 blizzards while I was in the hospital and we had the second worst winter in Philadelphia history. Being out on medical leave meant that i didn't have to worry about, or try to navigate, getting to work in snowy, icy conditions. Since I worked in healthcare I was expected to be at work no matter what the weather conditions were.
Maybe it would be a good idea to get an opinion from another myeloma specialist so you have some comparisons. Is there a reason why your husband is getting Revlimid non-stop without the 7 day break each cycle?
Nancy in Phila
The reason for 8 cycles of treatment was so that the transplant could be scheduled at a time where my sister was available to come and stay with me for 6 weeks. i also didn't want to have it right before Thanksgiving to ruin my holidays. As it turned out, having the transplant the end of January in 2010 was good timing. We had 2 blizzards while I was in the hospital and we had the second worst winter in Philadelphia history. Being out on medical leave meant that i didn't have to worry about, or try to navigate, getting to work in snowy, icy conditions. Since I worked in healthcare I was expected to be at work no matter what the weather conditions were.
Maybe it would be a good idea to get an opinion from another myeloma specialist so you have some comparisons. Is there a reason why your husband is getting Revlimid non-stop without the 7 day break each cycle?
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Revlimid prior to stem cell transplant - is it okay?
I underwent 4 cycles before my stem cell transplant back in May 2016. I believe a big part of the difference between the 4 and 6 cycles is the response that the doctor believes the patient will attain. My stem cell doctor and my myeloma specialist planned to start the stem cell transplant after 4 cycles, but if the numbers were still high would continue for another 2 cycles. Also, I was on Revlimid until 3 weeks before my transplant and completed my last Velcade injection 3 weeks before the transplant. From talking with the doctors the reason for the difference is the health of the person and also the potential for the numbers to increase when stopping treatment until the stem cell transplant. Someone whose number are likely to increase faster, the doctors are more likely to provide a shorter period before the transplant. This is information I was told when talking to the transplant team.
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Aclinkboca - Name: AC
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Dec 2015
- Age at diagnosis: 46
Re: Revlimid prior to stem cell transplant - is it okay?
My last day of 25 mg Revlimid will have been 11 days before my stem cell harvest. I completed 6 cycles of Revlimid, Velcade, and dexamethasone (RVD), skipping the Velcade the last cycle, in part because my M-protein was 0.12 g/dl (1.2 g/l) and some mild neuropathy. I will start Neupogen injections on September 17, two per day for 5 days. I'll also receive a Mozobil injection on September 20, and my stem cell harvest is scheduled for September 21 and September 22. My myeloma is IgA kappa.
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Adam W - Name: Adam W
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: April 2017
- Age at diagnosis: 48
Re: Revlimid prior to stem cell transplant - is it okay?
I'm also wondering about the effects of Revlimid before stem cell harvesting.
Re: Revlimid prior to stem cell transplant - is it okay?
Hhello Bozel100,
In the paper referenced below, the authors retrospectively studied the effect of Revlimid (lenalidomide) as induction therapy on stem cell collection. They found that the average number of stem cells collected was significantly less for the group of patients who took Revlimid. In their conclusion, they noted that up to four cycles of induction with Revlimid before stem cell harvest probably would not affect the stem cells.
Hope that answers your question , but I am sure that there may be more research on this topic too.
Reference
Bhutani, D, et al, "Evaluating the effects of lenalidomide induction therapy on peripheral stem cells collection in patients undergoing autologous stem cell transplant for multiple myeloma." Supportive Care in Cancer, Sep 2013 (abstract; full text of article at Pubmed Central)
Abstract
Introduction - Lenalidomide (LEN) is a relatively new and very effective therapy for multiple myeloma. Prior LEN therapy is associated with an increased risk of peripheral blood stem cell collection (PBSC) failure, particularly with filgrastim (G-CSF) alone. We performed a retrospective chart review of 319 consecutive multiple myeloma patients who underwent apheresis to collect PBSCs for the first autologous stem cell transplant (ASCT).
Results - The median number of PBSCs collected in the LEN (+) group was significantly less than the LEN (-) group (6.34 vs. 7.52 × 10(6) CD34(+) cells/kg; p = 0.0004). In addition, the median number of apheresis sessions required for adequate PBSCs collection were significantly more in the LEN (+) group as compared to LEN (-) group (2 vs. 1 sessions; p = 0.002). In the LEN (+) group, there was a negative correlation between PBSCs collected and prior number of cycles of LEN (p = 0.0001). Rate of PBSC collection failure was 9% in the LEN (+) group and 5% in the LEN (-) group (p = 0.16). Only six patients who failed PBSC collection with G-CSF were able to collect adequate PBSCs with G-CSF + plerixafor. LEN exposure had no effect on neutrophil or platelet recovery post-ASCT.
Conclusions - Up to four cycles of LEN exposure have minimal negative impact on PBSC collection. Despite prolong exposure of LEN, PBSC collection was adequate for two ASCTs in the majority of patients and post-ASCT engraftment was not longer than expected; however, clinical relevance (complication rate, quality of life, cost) of prolonged LEN exposure on both PBSC and ASCT, should be evaluated in prospective clinical trials.
In the paper referenced below, the authors retrospectively studied the effect of Revlimid (lenalidomide) as induction therapy on stem cell collection. They found that the average number of stem cells collected was significantly less for the group of patients who took Revlimid. In their conclusion, they noted that up to four cycles of induction with Revlimid before stem cell harvest probably would not affect the stem cells.
Hope that answers your question , but I am sure that there may be more research on this topic too.
Reference
Bhutani, D, et al, "Evaluating the effects of lenalidomide induction therapy on peripheral stem cells collection in patients undergoing autologous stem cell transplant for multiple myeloma." Supportive Care in Cancer, Sep 2013 (abstract; full text of article at Pubmed Central)
Abstract
Introduction - Lenalidomide (LEN) is a relatively new and very effective therapy for multiple myeloma. Prior LEN therapy is associated with an increased risk of peripheral blood stem cell collection (PBSC) failure, particularly with filgrastim (G-CSF) alone. We performed a retrospective chart review of 319 consecutive multiple myeloma patients who underwent apheresis to collect PBSCs for the first autologous stem cell transplant (ASCT).
Results - The median number of PBSCs collected in the LEN (+) group was significantly less than the LEN (-) group (6.34 vs. 7.52 × 10(6) CD34(+) cells/kg; p = 0.0004). In addition, the median number of apheresis sessions required for adequate PBSCs collection were significantly more in the LEN (+) group as compared to LEN (-) group (2 vs. 1 sessions; p = 0.002). In the LEN (+) group, there was a negative correlation between PBSCs collected and prior number of cycles of LEN (p = 0.0001). Rate of PBSC collection failure was 9% in the LEN (+) group and 5% in the LEN (-) group (p = 0.16). Only six patients who failed PBSC collection with G-CSF were able to collect adequate PBSCs with G-CSF + plerixafor. LEN exposure had no effect on neutrophil or platelet recovery post-ASCT.
Conclusions - Up to four cycles of LEN exposure have minimal negative impact on PBSC collection. Despite prolong exposure of LEN, PBSC collection was adequate for two ASCTs in the majority of patients and post-ASCT engraftment was not longer than expected; however, clinical relevance (complication rate, quality of life, cost) of prolonged LEN exposure on both PBSC and ASCT, should be evaluated in prospective clinical trials.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
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