[fetalsono]

Switching from Cytoxan to Revlimid - side effects?

by fetalsono on Tue Jun 10, 2014 7:19 pm

I was originally diagnosed with smoldering myeloma a year ago. My light chains began to creep up as did my creatinine and my hematologist started me on Velcade / Cytoxan [cyclo­phos­pha­mide] / dex (VCD).

I am now in my 4th round of therapy. My light chains have come down to 400 and my creatinine is stable - around 1.9 (has not really come down).

Either to try something different or ultimately for maintenance therapy, my doctor has mentioned Revlimid instead of Cytoxan. I am curious about the side effects.

I have had a mild neuropathy for several years (not increased with Velcade) and I am chronically on Plavix and aspirin for coronary stents (so theoretically no concern about DVT).

Curious about benefits (renal) and side effects.

Thanks

[Dr. Ken Shain]

Re: Switching from Cytoxan to Revlimid - side effects?

by Dr. Ken Shain on Wed Jun 11, 2014 7:10 am

Without knowing your history, disease course and response I cannot comment on the rationale for switching to Revlimid (lenalidomide) from Cytoxan.

However, Revlimid is a very nice therapeutic for myeloma patients. It is generally a well tolerated medication. Most people will experience only mild side effects, with most of the side effects managed with dose reductions or supportive care.

As you mentioned VTE (DVTs and PEs) are important side effects that are typically prevented by appropriate prophylaxis (aspirin, Coumadin or low molecular weight heparins) -- Plavix should be just fine too.

[VTE = venous thromboembolism; DVT = deep vein thrombosis; PE = pulmonary embolism]

The most common side effect of Revlimid is fatigue, which can range from "no bid deal" to stuck in bed. Rash, GI cramping / discomfort, decreased appetite, diarrhea / constipation, muscle cramps with long term use, myelosuppression (decrease WBC, RBC and platelets), to name a few.

Neuropathy is not typical of Revlimid (but it can be of Revlimid's "cousin", thalidomide).

I am sure that others who have been on Revlimid can also give excellent insight into their experiences on Revlimid - I would think mostly quite positive. Revlimid and Velcade are key components to the marked improvement in outcomes we see in our patients today.

Take care.

[Wayne K]

Re: Switching from Cytoxan to Revlimid - side effects?

by Wayne K on Wed Jun 11, 2014 12:52 pm

I'm on my third cycle of Revlimid to counter a rise in my light chains.

The most noticeable thing about side effects for me has been that they have lightened up. My first cycle had me so tired that I could barely function -- constipation, neuropathy in my lips, and nausea. Since then, the subsequent cycles have had less intensity in the side effects. I have picked up some new ones, but aside from still being more fatigued that I would like, the side effects don't really cause me a lot of stress.