[coachhoke]

Seeking opinions about treatment

by coachhoke on Fri Aug 02, 2013 4:21 pm

Hey guys,

I’m 72. Diagnosed April 2012 on a fluke (no multiple myeloma symptoms)( M-spike 0.9) treated with Velcade plus dex for 6 months. M-spike dropped to 0.3 and has stayed there. Since January 2012 only treatment is 21 day cycles, off a week,etc. with 10 mg. Revlimid.

Question: Stay on 10 mg cycles of Rev? add Dex? reduce to 5mg? stop treatment altogether? Only side effects are fatigue , insomnia, and horrible taste in mouth. I have multiple lytic lesions on spine, but no pain (not active ,based on PT/Cat scan) Seeking opinions.

thanks,
DON

[coachhoke]

Re: Seeking opinions about treatment

by coachhoke on Fri Aug 02, 2013 4:43 pm

Rev since Jan 2013 not 2012

[Dr. Ken Shain]

Re: Seeking opinions about treatment

by Dr. Ken Shain on Sat Aug 03, 2013 9:52 am

You have achieved a partial response (between a 50 and 90% reduction of paraprotein -M-spike). Many patients reach a plateau. We all want to see a complete response, but not all patients will acheive that depth of response. The most important aspect is to gain control of disease-at level below which it is causing organ damage. In your care, I would continue on Rev maintenance therapy indefinitely. With the caveate that quality of life be taken into account. Decreased dosing (to 5mg) may provide equivalent effecicacy with an improved tolerance. But that will need to be a discussion between you and your oncologist.

Do you live in the United States? Another thought would be to consider consolidation with a HDM-ASCT. Again, this would depend on your transplant eiligability (heath status outside of the myeloma).

[coachhoke]

Re: Seeking opinions about treatment

by coachhoke on Sat Aug 03, 2013 1:29 pm

Thanks Dr. Shain for offering your opinion .
I am in excellent health: x-marathon runner ( until osteo arthritis of knees); now walk, bike, or swim daily; normal B.P. and heart rate, no diabetes or any allergies or other health issues.
I thought I'd live to 100 until multiple myeloma was diagnosed.
Induction therapy with Velcade and DEX went fairly well (0.9 to 0.3 M-spike) minimal side effects :slight neuropothy , weight gain, blurry eyes, typical insomnia and crankiness associated with steroids. Revlimid maintainance is tolerable but way less energy and other minor issues than I've been used to for 71 years.
I live in Harrisburg, PA.
I really don 't want to do a transplant as risk/reward seems not to warrant it.(Still requiring maintainance).
It seems maybe I should play with the dose and frequency of the Revlimid to see what I tolerate the best.
thanks again and all opinions are appreciated.

Coach Hoke