My mother lives in India and she was diagnosed with multiple myeloma last month. I live in Oregon and I'm trying to get a second opinion on her treatment.
Diagnosis: Bone pain and lytic lesions discovered through PET scans on 2 vertebral bones and ulna bone on right arm. She has also experienced bone pain one of her ribs were PET scan did not find anything.
Bone marrow biopsy from one affected bone called this disease plasmacytoma.
SFLC assay: high kappa of 1290 and high kappa to lambda ratio of 45.
Beta 2 microglobulin of 2.45
The blood work is fairly normal with heamoglobin level of 11.4 and DLC is fairly normal too. CBC is done every week. SLFC assay and urine electrophoresis is scheduled once a month.
My parents live in a small town in India. We had to take my mother to Mumbai to one of the most reputed haemato-oncologists in India for diagnosis and treatment. He prescribed a long list of medications. Primary chemo meds are Velcade + dexamethasone once a week and Treanda (bendamustine) once a month. He wants to keep her on this medication for 2 months and then look at the patient again and possibly decide if stem cell transplant is needed.
We brought my mother back to our hometown where we are getting chemo done under the supervision of a local oncologist who does not have too much experience with multiple myeloma. The doctor in Mumbai has asked us to bring back the patient after 2 months on this chemo treatment and is not very closely involved with the treatment due to the distance.
I looked at induction therapy options on Myeloma Beacon but did not see anything about Velcade+ Treanda + dexamethasone as one of the common options. I'm wondering if someone here can comment on the use of these drugs for early multiple myeloma treatment.
Also, is it common to stay on the same chemo for 2 full months before the doctor reevaluates the situation and possibly change meds?
Thanks to all who reply!
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Re: Second opinion on treatment
Sorry to hear about your mother's diagnosis, Shukla. I hope she responds well to the treatment she's receiving.
Velcade + dex + Treanda (bendamustine) would be a somewhat odd initial therapy for a myeloma patient. To be honest, I don't think we've seen anyone else here in the forum who has had that initial therapy. However, the regimen has been tested in newly diagnosed patients in at least one clinical trial. See, for example, this study:
J Berdeja et al., "Bendamustine, Bortezomib and Dexamethasone (BBD) As First-Line Treatment Of Patients (Pts) With Multiple Myeloma Who Are Not Candidates For High Dose Chemotherapy," ASH 2013 abstract #3193.
Are you sure the regimen isn't Velcade + dex + thalidomide? I think we've heard here in the forum of that therapy being used in India.
Treanda is in the same general class of drugs as cyclophosphamide (Cytoxan) and melphalan. In the U.S. and in other countries, Velcade + cyclophosphamide + dex (VCD, CyBorD) is a common initial treatment regimen. Outside the U.S., you'll also find Velcade + melphalan + prednisone (a steroid similar to dex) (VMP) being used as initial therapy for myeloma patients.
In any case, Velcade-dex-Treanda is not unheard of as initial therapy, but it's uncommon.
Velcade + dex + Treanda (bendamustine) would be a somewhat odd initial therapy for a myeloma patient. To be honest, I don't think we've seen anyone else here in the forum who has had that initial therapy. However, the regimen has been tested in newly diagnosed patients in at least one clinical trial. See, for example, this study:
J Berdeja et al., "Bendamustine, Bortezomib and Dexamethasone (BBD) As First-Line Treatment Of Patients (Pts) With Multiple Myeloma Who Are Not Candidates For High Dose Chemotherapy," ASH 2013 abstract #3193.
Are you sure the regimen isn't Velcade + dex + thalidomide? I think we've heard here in the forum of that therapy being used in India.
Treanda is in the same general class of drugs as cyclophosphamide (Cytoxan) and melphalan. In the U.S. and in other countries, Velcade + cyclophosphamide + dex (VCD, CyBorD) is a common initial treatment regimen. Outside the U.S., you'll also find Velcade + melphalan + prednisone (a steroid similar to dex) (VMP) being used as initial therapy for myeloma patients.
In any case, Velcade-dex-Treanda is not unheard of as initial therapy, but it's uncommon.
Re: Second opinion on treatment
Cheryl,
Thank you for your well thought out reply. It was very informative.
The link you shared describes Velcade + Treanda + dex combination as a 'milder' multiple myeloma treatment for patients who cannot receive high dose chemo. I guess it is a strange choice of meds, given my mother is younger (54 years) and in good general health. We will probably ask the doctor to reconsider the choice of drugs if the serum FLC assay results from this month look bad.
I had one more question. I noticed that Revlimid (lenalidomide) is a popular drug for multiple myeloma but this was not prescribed to my mother even though it is now available in India. Is Revlimid not commonly used in early multiple myeloma treatment?
BTW, while it is hard to recover from the shock of my mother's diagnosis, I am really thankful for the support of member of this forum for their help with our fight with multiple myeloma in the months and years ahead.
Thank you for your well thought out reply. It was very informative.
The link you shared describes Velcade + Treanda + dex combination as a 'milder' multiple myeloma treatment for patients who cannot receive high dose chemo. I guess it is a strange choice of meds, given my mother is younger (54 years) and in good general health. We will probably ask the doctor to reconsider the choice of drugs if the serum FLC assay results from this month look bad.
I had one more question. I noticed that Revlimid (lenalidomide) is a popular drug for multiple myeloma but this was not prescribed to my mother even though it is now available in India. Is Revlimid not commonly used in early multiple myeloma treatment?
BTW, while it is hard to recover from the shock of my mother's diagnosis, I am really thankful for the support of member of this forum for their help with our fight with multiple myeloma in the months and years ahead.
Re: Second opinion on treatment
My mom's induction chemo and current chemo is RVD (Velcade and Revlimid). It worked great for her, and from what I gather it is very common in the U.S. to start off on Revlimid and Velcade, or just one of those treatments.
Re: Second opinion on treatment
Revlimid is a very common initial treatment drug which is often given in combination with Velcade and dexamethasone. I started with Revlimid and dex. When I relapsed about 3 years post ASCT, I was restarted on Revlimid and dex again with extremely good results. Revlimid also is the most common drug used as maintenance therapy after a stem cell transplant.
Nancy in Phila
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: Second opinion on treatment
Revlimid is a common first line treatment in the U.S., but not as common first line in other countries. Many people on this website are from the U.S., so it influences perceptions of what is "normal" first line treatment.
I'm in Canada. Revlimid is still more of a second line treatment here. Not used as commonly for first induction. Velcade was only approved a few years ago for first line treatment.
Anyway, it's all kind of confusing depending where you live and what is available. Is the local oncologist going to follow your mom with regular blood work during chemo? I think it's ok to see the myeloma specialist occasionally as long as the local onc is monitoring everything.
I'm in Canada. Revlimid is still more of a second line treatment here. Not used as commonly for first induction. Velcade was only approved a few years ago for first line treatment.
Anyway, it's all kind of confusing depending where you live and what is available. Is the local oncologist going to follow your mom with regular blood work during chemo? I think it's ok to see the myeloma specialist occasionally as long as the local onc is monitoring everything.
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lys2012 - Name: Alyssa
- When were you/they diagnosed?: 2010, Toronto, Canada
- Age at diagnosis: 32
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