[Steve]

RVD and stroke-like symptoms

by Steve on Mon Sep 24, 2012 9:55 am

Hello all,

Thought I'd run this one by all of you to see if anyone has encountered anything similar.

Last Monday I was driving myself to receive a Velcade injection. I'm on a 21 day cycle.14 days of Revlimid concurrently with Velcade/Dex on days 1, 4, 8, and 11..and then 7 days off. That week concluded the third cycle of RVD.

At any rate, on the way to the appointment I noticed my driving was not quite what it should be, e.g., stopping was delayed. I would "overshoot" my intended stopping point by 5 -10 feet.. That happened a couple of times and otherwise my driving seemed to be okay.

However, after the injection the nurse detected that my behavior seemed to be suggestive of a TIA/stroke (confusion, loss of immediate memory etc.) [TIA="transient ischemic event, aka "mini-stroke"]. So, I'm put on a saline drip and then transported to the ER.... subsequently admitted to the hospital cardiac unit for testing. Long story short, the tests show no evidence of blockage or even reduced blood flow, or any neurological abnormalities. (A chest X-ray did show what appears to be very mild pneumonia which is being treated with antibiotic Avelox.) My CBC/CMP indicated my blood levels were all in range sufficiently to receive the Velcade.

Some of the doctors who treated me feel, at least at this point, that dehydration caused the mental lapses and stroke-like symptoms. (From a cardio-pulmonary and neurological perspective the tests indicated that things look fine.) One or two of the doctors may still suspect TIA...not dehydration.

To date, I haven't found any connections in the literature between RVD and cases of dehydration causing stroke-like symptoms. (Otherwise, my side effects to the RVD thus far have been some PN in the feet, fatigue and drowsiness, some light-headedness, sense of lack of coordination and a bit of constipation.....but no vomiting or diarrhea that would indicate severe loss of fluids.)

So, wondering if any of you have encountered anything quite like this in your treatment with RVD or other chemo combinations?

Thanks,

Steve
Age: 58
Dx: 12/09

p.s. -- I should add that I've been on Coumadin for over six years and my BP has always been fine.

[suzierose]

Re: RVD and stroke-like symptoms

by suzierose on Mon Sep 24, 2012 2:09 pm

Hi Steve,

Your symptoms do sound consistent with TIA and there need not be pre-existing dehydration or cardiovascular disease and/or risk factors to trigger a TIA

In terms of arterial thromboembolism cerebrovascular events have been reported with thalidomide.
"We describe 5 unusual arterial thromboses in patients with multiple myeloma shortly after beginning thalidomide-based therapies. The cases are remarkable for a paucity of risk factors and short latency. We also review the literature on arterial thromboembolic events in patients taking thalidomide."

It is notable that the patients, just like you, did not have prior risk factors and that the events were brief which is what a TIA is.

Safety data on lenalidomide shows this:
"Arterial thromboembolic events (ATEs) occurred in 2·9% of patients. ATEs included myocardial infarction (0·5%), transient ischaemic attack (0·4%), cerebrovascular accident (0·4%), and thrombotic stroke (0·1%). Only 1·8% of these patients had an grade ≥3, although 6 (0·4%) patients experienced grade 5 ATEs."
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.2009.07728.x/full

Worldwide safety data from 2009 shows:
"A total of 493 reports of arterial thromboembolic events had been received by the licence holder from all sources worldwide up to Dec 26, 2009. Review of these reports showed a preponderance of cardiac events (mainly myocardial infarctions: 319 reports, 65%). Cerebral vascular events, including transient ischaemic attack, were reported in 17% of cases. The overall reporting rate for arterial thromboembolic events was estimated to be 0.5%, but the true rate is likely to be higher because of under-reporting of reactions."
http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON108684

[Steve]

Re: RVD and stroke-like symptoms

by Steve on Wed Sep 26, 2012 11:33 am

Hi SuzieRose,

Thanks so much for your thorough response....I'm going to be following-up today with my hemonc. It will be interesting to see what he recommends.

Best,

Steve

[kmahlf]

Re: RVD and stroke-like symptoms

by kmahlf on Wed Jun 19, 2013 5:45 pm

This is the same thing that happened to me on Monday, June 18th, while driving to work. I went to stop at light and ended up running into the back of car in front of me. I was just as surprised as the occupants of the car I hit.

I seem to be fine but have intermittent memory snafu's where I can't get my thoughts out.

I seem, according to my wife and family, to go into great, long detail and rather than just give a short response, I take forever to tell my story.

This is a real recent event ... beginning a few days ago. I have been known as A man of few words all my life.

I will ask my Dr about TIA . Do you think I need to be seen before 6 more days?

[Beepers]

Re: RVD and stroke-like symptoms

by Beepers on Sat Feb 01, 2014 3:03 am

I have had multiple myeloma for 14 years. I have had multiple TIA symptoms, and was once treated for a stroke. All tests (CTS, MRI) have all been negative. I hope we finally hit it. Dehydration. It's hard to detect because dry mouth and odd colored urine come with the territory. I will be ever mindful of diarrhea, vomiting, sweating, or any other situations, like cold or flu, which make you lose fluids. And remember, replace lost fluids where ever they occur. (You do not want to spend time in the hospital like I did to learn this lesson.)

[kjpoppit]

Re: RVD and stroke-like symptoms

by kjpoppit on Sat Feb 01, 2014 5:29 am

Interesting. I am on CyBorD but have experienced some memory or time response issues. I was thinking more of"chemo brain" Just today driving to the doctor for my Velcade shot, I almost ran a red light. I caught myself and slid a little into the intersection, there were no other cars around luckily. Then shortly later I came upon a familiar roundabout but was surprised by it and the change in the road. Felt a little disoriented.

I am slower on some word recall and some computer tasks take longer to think through now. I feel the memory issues are real but everyone around me insists its age and they have it too. I don't feel that's it. I am different now.

Hope you have no more problems with this.

[Multibilly]

Re: RVD and stroke-like symptoms

by Multibilly on Sat Feb 01, 2014 8:47 am

Note that dehydration is clearly listed as one of the severe adverse reactions due to Velcade. Food for thought.

http://www.drugs.com/pro/Velcade.html

Rev can also cause dehydration.

http://www.drugs.com/pro/Revlimid.html

My onc told me that you always want to be hyper vigilant about keeping hydrated with any stage of multiple myeloma, including MGUS and smoldering...and whether you are on treatment or not.

[wesley]

Re: RVD and stroke-like symptoms

by wesley on Sat Feb 01, 2014 10:17 pm

I started initial induction therapy Sept 1 of 2013 (Revlimid/Dex). Had a TIA with left side weakness late in the day on Oct 16. Had a full stroke workup that night. No damage in my brain. Docs said they did not know whether to attribute this to multiple myeloma, to Revlimid, to the combination, or to some other cause. Fortunately symptoms (gait only, no cognitive or visual disturbance) resolved in 2 hours. No residual effect. But it was a scary two hours. I tried to stay really hydrated last fall - but I guess I can't rule out dehydration either.

Arrived Thursday at Mayo Rochester for ASCT - two days of Neupogen so far. No pain at all. But I am taking Tylenol and Claritin each am before I head over to the hospital. Central line goes on Monday. Then the game really begins - to use a Super Bowl analogy.

Staying at Gift of Life Transplant House - grateful for heated indoor parking!!

Regards to all

Wesley