Hi to everybody!
Just wanted to tell all of you contributing in these forums that I am so happy you do! Feels like you´re all my "second" family!
My question;
I recently found out from a gene expression profiling that my multiple myeloma cells show a high expression of surface marker CD20. It was suggested that Rituxan (rituximab) might be used for treatment. Does anyone here have any experience of that?
Moderator's note: Rituxan (rituximab) is sold under the brand name MabThera in Europe and many other countries.
Forums
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asaryden - Name: asaryden
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: August 2010
- Age at diagnosis: 48
Re: Rituxan (rituximab) for treatment of multiple myeloma?
Hello from rainy Seattle!
Can rituximab [Rituxan / MabThera] be used for multiple myeloma? This is an interesting question and one I have thought a lot about. Rituximab is a breakthrough drug for patients with non hodgkins lymphoma (NHL) and many other blood cancers. Unfortunately most patients with myeloma do not express the surface antigen CD20 on the their plasma cells that allows rituximab to work. To be sure that your myeloma has CD20 on the surface of the cells one would want to use flow cytometry to test for this. Flow cytometry has probably already been done on the cells when you had your bone marrow biopsy at diagnosis. Your oncologist can look this up.
Multiple myeloma patients with the genetic change detected by FISH of t(11;14) do express CD20 on the surface of their myeloma cells. Approximately 15% of patients with myeloma have t(11;14). Apparently though myeloma is resistant to rituximab. This idea has been tested clinically.
French investigators gave rituximab to 14 patients with high CD 20 expression but there was only a marginal response. Leukemia (2007) 21, 835–836. Several factors have been described to explain resistance against rituximab but the bottom line is that we dont know why myeloma is resistant but it is. Hopefully more research will unravel the reasons and we will be able to use drugs like Rituximab in selected myeloma patients.
The GOOD NEWS is that the myeloma world may not need rituximab though ! New drugs have been developed that attach other surface markers on myeloma cells. These drugs attack surface markers that are on all myeloma cells so the drugs should work in all patients. The first drug of this type is elotuzumab. Elotuzumab is an antibody directed against CS1- a surface marker present on all patients with myeloma. Keep an eye on this drug. Investigators are very excited about its effect on myeloma especially when combined with Revlimid. Phase III trials are underway for elotuzumab in myeloma.
Best of luck in your journey with this challenging disease.
Can rituximab [Rituxan / MabThera] be used for multiple myeloma? This is an interesting question and one I have thought a lot about. Rituximab is a breakthrough drug for patients with non hodgkins lymphoma (NHL) and many other blood cancers. Unfortunately most patients with myeloma do not express the surface antigen CD20 on the their plasma cells that allows rituximab to work. To be sure that your myeloma has CD20 on the surface of the cells one would want to use flow cytometry to test for this. Flow cytometry has probably already been done on the cells when you had your bone marrow biopsy at diagnosis. Your oncologist can look this up.
Multiple myeloma patients with the genetic change detected by FISH of t(11;14) do express CD20 on the surface of their myeloma cells. Approximately 15% of patients with myeloma have t(11;14). Apparently though myeloma is resistant to rituximab. This idea has been tested clinically.
French investigators gave rituximab to 14 patients with high CD 20 expression but there was only a marginal response. Leukemia (2007) 21, 835–836. Several factors have been described to explain resistance against rituximab but the bottom line is that we dont know why myeloma is resistant but it is. Hopefully more research will unravel the reasons and we will be able to use drugs like Rituximab in selected myeloma patients.
The GOOD NEWS is that the myeloma world may not need rituximab though ! New drugs have been developed that attach other surface markers on myeloma cells. These drugs attack surface markers that are on all myeloma cells so the drugs should work in all patients. The first drug of this type is elotuzumab. Elotuzumab is an antibody directed against CS1- a surface marker present on all patients with myeloma. Keep an eye on this drug. Investigators are very excited about its effect on myeloma especially when combined with Revlimid. Phase III trials are underway for elotuzumab in myeloma.
Best of luck in your journey with this challenging disease.
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Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
Re: Rituxan (rituximab) for treatment of multiple myeloma?
I greatly appreciate the contibutions from Dr. Libby and the other doctors. I have found them very helpful in understanding the details of this complicated disease.
Im one of the 15% of multiple myeloma patients with t(11;14), and have considered Rituxin. I read the following in the comments on the cancer treatments website in 2010. Oncologists I have spoken to thought it might be worth trying, especially if I run out of other options.
Arizonan
Rituxan for CD20 positive myeloma
Interest in using Rituxan for subsets of myeloma with CD20 positivity, was provoked by a Phase II study of Moreau et al evaluating four weekly infusions of single-agent rituximab (375 mg/m2) therapy in a cohort of patients with CD20+ multiple myeloma (multiple myeloma) with either stage I, never treated disease, or stage III multiple myeloma in relapse, or refractory after two lines of therapy. The authors concluded that rituximab as a single agent had minor activity in this cohort of patients with CD20 expression on at least 33% of tumor cells. A 2008 review concluded: "Clinical trials show that anti-CD20 therapy with rituximab elicits a partial response in approximately 10% of CD20+ patients with multiple myeloma. In addition, there is preliminary evidence of disease stabilization in 50-57% of CD20+ patients for a period of 10-27 months. Further large-scale clinical trials are therefore needed to establish the role of this promising strategy in the treatment of myeloma." There are several other reports in different settings, including in maintenance.
J M Bergua, C Cabrera, E G Arteta and J Prieto
Rituximab in CD20 positive multiple myeloma, Letter to the Editor, Leukemia 22, 1082-1083 (May 2008)
P Moreau, L Voillat, L Benboukher, C Mathiot, C Dumontet, N Robillard, O Hérault, F Garnache, R Garand, N Varoqueaux, H Avet-Loiseau, J L Harousseau and R Bataille
Rituximab in CD20 positive multiple myeloma, Leukemia 21, 835-836 (April 2007)
Kapoor P, Greipp PT, Morice WG, Rajkumar SV, Witzig TE, Greipp PR.
Anti-CD20 monoclonal antibody therapy in multiple myeloma.
Br J Haematol. 2008 Apr;141(2):135-48. Epub 2008 Mar 3.
Long-term response to maintenance treatment with rituximab in CD20+ multiple myeloma
Hitoshi OhnoLeukemia & Lymphoma
November 2010, Vol. 51, No. 11 : Pages 2144-2146
Im one of the 15% of multiple myeloma patients with t(11;14), and have considered Rituxin. I read the following in the comments on the cancer treatments website in 2010. Oncologists I have spoken to thought it might be worth trying, especially if I run out of other options.
Arizonan
Rituxan for CD20 positive myeloma
Interest in using Rituxan for subsets of myeloma with CD20 positivity, was provoked by a Phase II study of Moreau et al evaluating four weekly infusions of single-agent rituximab (375 mg/m2) therapy in a cohort of patients with CD20+ multiple myeloma (multiple myeloma) with either stage I, never treated disease, or stage III multiple myeloma in relapse, or refractory after two lines of therapy. The authors concluded that rituximab as a single agent had minor activity in this cohort of patients with CD20 expression on at least 33% of tumor cells. A 2008 review concluded: "Clinical trials show that anti-CD20 therapy with rituximab elicits a partial response in approximately 10% of CD20+ patients with multiple myeloma. In addition, there is preliminary evidence of disease stabilization in 50-57% of CD20+ patients for a period of 10-27 months. Further large-scale clinical trials are therefore needed to establish the role of this promising strategy in the treatment of myeloma." There are several other reports in different settings, including in maintenance.
J M Bergua, C Cabrera, E G Arteta and J Prieto
Rituximab in CD20 positive multiple myeloma, Letter to the Editor, Leukemia 22, 1082-1083 (May 2008)
P Moreau, L Voillat, L Benboukher, C Mathiot, C Dumontet, N Robillard, O Hérault, F Garnache, R Garand, N Varoqueaux, H Avet-Loiseau, J L Harousseau and R Bataille
Rituximab in CD20 positive multiple myeloma, Leukemia 21, 835-836 (April 2007)
Kapoor P, Greipp PT, Morice WG, Rajkumar SV, Witzig TE, Greipp PR.
Anti-CD20 monoclonal antibody therapy in multiple myeloma.
Br J Haematol. 2008 Apr;141(2):135-48. Epub 2008 Mar 3.
Long-term response to maintenance treatment with rituximab in CD20+ multiple myeloma
Hitoshi OhnoLeukemia & Lymphoma
November 2010, Vol. 51, No. 11 : Pages 2144-2146
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Arizonan - Name: Arizonan
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: April 2010
- Age at diagnosis: 54
Re: Rituxan (rituximab) for treatment of multiple myeloma?
Thank you Dr Libby and Arizonan for your comments.
I can see that the results from clinical trials are not too exciting for rituximab although some seem to benefit. Maybe it needs to be combined with something else?
I am currently on maintenance treatment with Velcade and I did see a study on Lymphoma with Velcade and rituximab with good results for some patients. I was thinking that adding rituximab to Velcade might get me into complete remission since I am CD20+. At this moment my lambda light chains are 0 mg/24 hours but can be detected by immunofixation. I am high risk according to GEP80 and presence of del17p (detected at diagnosis but not after ASCT) and don’t feel I have the time to sit and wait for new treatments.
It may be difficult though to get my doctor to agree to try this if the results from clinical trials are somewhat "luke warm".
I can see that the results from clinical trials are not too exciting for rituximab although some seem to benefit. Maybe it needs to be combined with something else?
I am currently on maintenance treatment with Velcade and I did see a study on Lymphoma with Velcade and rituximab with good results for some patients. I was thinking that adding rituximab to Velcade might get me into complete remission since I am CD20+. At this moment my lambda light chains are 0 mg/24 hours but can be detected by immunofixation. I am high risk according to GEP80 and presence of del17p (detected at diagnosis but not after ASCT) and don’t feel I have the time to sit and wait for new treatments.
It may be difficult though to get my doctor to agree to try this if the results from clinical trials are somewhat "luke warm".
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asaryden - Name: asaryden
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: August 2010
- Age at diagnosis: 48
Re: Rituxan (rituximab) for treatment of multiple myeloma?
I have been classified as having Waldenstrom like multiple myeloma based on gene array characterization. I have taken 6 doses of rituxan and it is the first medicine that has stabilized my multiple myeloma. Unfortunately, rituxan has not been approved by the FDA for multiple myeloma. Therefore neither medicare nor my private insurance will pay. The cost is $31,000/dose. I simply cannot afford this treatment although my oncologist wants me to take monthly doses.
It is a pretty sad situation. We now have the tools for personalized medicine and can identify wshat medicines to use....but sadly...the FDA wants long term clinical trials before they will give their blessing. I only hope that enough patients take and use the product so that the manufacturers will try to get a label extension for multiple myeloma patients like myself that could benefit from this medicine.
It is a pretty sad situation. We now have the tools for personalized medicine and can identify wshat medicines to use....but sadly...the FDA wants long term clinical trials before they will give their blessing. I only hope that enough patients take and use the product so that the manufacturers will try to get a label extension for multiple myeloma patients like myself that could benefit from this medicine.
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garyeblau
Re: Rituximab for treatment of multiple myeloma?
Garyeblau, I too have been classified as having Waldenström like multiple myeloma. Did you go to UAMS too?
It is interesting to hear that rituximab did have an effect. Did you get it monthly? At what doses? Any side effects?
I’m so sorry to hear about the rigid system though for getting this medicine in the US. And the cost that you mention is really outrageous! Perhaps there are other ways to get this medicine that visitors to this site are aware of?
It is interesting to hear that rituximab did have an effect. Did you get it monthly? At what doses? Any side effects?
I’m so sorry to hear about the rigid system though for getting this medicine in the US. And the cost that you mention is really outrageous! Perhaps there are other ways to get this medicine that visitors to this site are aware of?
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asaryden - Name: asaryden
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: August 2010
- Age at diagnosis: 48
Re: Rituxan (rituximab) for treatment of multiple myeloma?
My husband is currently on single agent rituximab [Rituxan], after relapsing last November. He had been in complete remission for the last 2 1/2 yrs, following tandem transplants and relapsed during his 3rd year of maintenance therapy with Velcade. So far the rituximab appears to be working, and we will see with his next series of follow up tests if we will combine a chemotherapy option, such as Revlimid with the rituximab.
As with a few others, my husband was also told he had Waldenstrom-like Myeloma, when he relapsed, and his tests showed that he was CD-20 positive and had t (11/14). These are new mutations seen at relapse, that he did not have previously.
Through UAMS, we found out that the manufacturer of rituximab, Celgene, has a patient assistance program, and with your doctor's cooperation, and a couple of applications, you can get help from Celgene to receive your treatment. The info is on their website.
Good luck to those wanting to try these new monoclonal antibodies...these targeted therapies appear to have less overall toxicity.
debi
Moderator's Note: The company that sells Rituxan (rituximab, MabThera) in the U.S. is Genentech, which is a subsidiary of Roche, the company that sells the drug outside the U.S.
As with a few others, my husband was also told he had Waldenstrom-like Myeloma, when he relapsed, and his tests showed that he was CD-20 positive and had t (11/14). These are new mutations seen at relapse, that he did not have previously.
Through UAMS, we found out that the manufacturer of rituximab, Celgene, has a patient assistance program, and with your doctor's cooperation, and a couple of applications, you can get help from Celgene to receive your treatment. The info is on their website.
Good luck to those wanting to try these new monoclonal antibodies...these targeted therapies appear to have less overall toxicity.
debi
Moderator's Note: The company that sells Rituxan (rituximab, MabThera) in the U.S. is Genentech, which is a subsidiary of Roche, the company that sells the drug outside the U.S.
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debi
Re: Rituximab for treatment of multiple myeloma?
Thanks Debi
I am glad he is doing well. How often did he take the Rituxan in the beginning? Any problems with side effects?
Thanks
David
I am glad he is doing well. How often did he take the Rituxan in the beginning? Any problems with side effects?
Thanks
David
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Arizonan - Name: Arizonan
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: April 2010
- Age at diagnosis: 54
Re: Rituxan (rituximab) for treatment of multiple myeloma?
Here is an interesting study from ASH 2012; treatment with a radiolabled anti-CD20 antibody.
Blood (ASH Annual Meeting Abstracts) 2012 120: Abstract 1854
A Phase II Study of Consolidation Treatment with Iodione-131 Tositumomab (Bexxar™) in Multiple Myeloma (multiple myeloma)
"Conclusion: I-131 tositumomab is well-tolerated in patients with previously treated multiple myeloma and produces objective responses including CRs. ORR was significantly higher in CD20 positive compared with CD20 negative disease: 67% vs. 10% (p=0.036). Achievement of response is delayed compared to what is observed with standard multiple myeloma therapy. While we continue to investigate its effects on multiple myeloma "stem cells," these results indicate that I-131 tositumomab produces highly durable responses in CD20 positive multiple myeloma."
Åsa
https://ash.confex.com/ash/2012/webprogram/Paper54928.html
Blood (ASH Annual Meeting Abstracts) 2012 120: Abstract 1854
A Phase II Study of Consolidation Treatment with Iodione-131 Tositumomab (Bexxar™) in Multiple Myeloma (multiple myeloma)
"Conclusion: I-131 tositumomab is well-tolerated in patients with previously treated multiple myeloma and produces objective responses including CRs. ORR was significantly higher in CD20 positive compared with CD20 negative disease: 67% vs. 10% (p=0.036). Achievement of response is delayed compared to what is observed with standard multiple myeloma therapy. While we continue to investigate its effects on multiple myeloma "stem cells," these results indicate that I-131 tositumomab produces highly durable responses in CD20 positive multiple myeloma."
Åsa
https://ash.confex.com/ash/2012/webprogram/Paper54928.html
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asaryden - Name: asaryden
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: August 2010
- Age at diagnosis: 48
Re: Rituxan (rituximab) for treatment of multiple myeloma?
I have plasmablastic lymphoma /myeloma depending what doctors you believe. The pathology reports from Stanford medical all come back as plasmabkastic but my doctors are treating me like I might have multiple myeloma. The reason for the post is to give you an up date on rituxan/Velcade treatment option.Two years ago I receive r-chop and than 25 days of radiation on a tumor in my stomach. R chop was a waste of time and while the radiation help the tumor in my lymnodes around the stomach the cancer was poping up around the body. It was decided the I would start a rice and Velcade treatment but with the tumors being quiet big in a couple location they decieded to give me one treatment of just rituxan and Velcade. Well that might be the best decision that I .made since starting this cancer jourey . After one round some tumors have been completely disappeared and the other tumors have lost size (25 to 50%) I think since I have cd20 expression on the tumors rituxan with Velcade is worth a try. Forget what the doctors say and all the studies say. You got to try everything we can .
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ontheblock - Name: rod
- Who do you know with myeloma?: me
- When were you/they diagnosed?: 6/01Z/2011
- Age at diagnosis: 45
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