My mother had an appointment at Mayo yesterday. She is on her third cycle of RVD (Revlimid, Velcade, dexamethasone), which is not working. Her IgA has risen. She has had a plasmacytoma near her uterus, which has shrunk (yay!), but there are two (very small) new spots that showed up on the PET, one near her heart and one near her kidneys.
The plan is to proceed to a second auto transplant as soon as possible (most likely one to two months). In the meantime, she will switch to Pomalyst, Kyprolis and dex. Her doctor considered CYCLONE and VDT-PACE, but thought that PKd (is that the right acronym?) was the best option as it could give her some valuable information about what to use for maintenance.
I hear the Pomalyst works well on extramedullary tumors, so I am hoping it works its magic in this case!
We also got the results of her FISH study. They tried to do one back at her diagnosis in 2008 but weren't able to. We did find out through other testing at that time that she has del 13. The FISH tests shows translocation 4;14 and gain 1q. Mom's doctor said the 1q gain is recent and she thought that the t(4;14) had been there since 2008.
I've been reading up on these and it seems like maybe 4;14 isn't sensitive to high-dose melphalan. I wish we knew for certain if the t(4;14) is an older issue. Mom's 2008 transplant gave her 5.5 years drug-free stringent complete remission (sCR). So if t(4;14) was around then, maybe it's not too much of a worry and she can have a long remission on a second transplant? On the other hand, if it's newer, is a transplant worth it?
I also read about how Velcade can make t(4;14) into more of a standard risk. Mom will be switching over to Kyprolis, but since that is a proteasome inhibitor too, maybe it will have the same effect?
On the other hand, I also read how a 1q gain can cause Velcade resistance. So does that cancel out the effects of the proteasome inhibitor, making t(4;14) still high risk and making the transplant not last long? Assuming the t(4;14) has been around since diagnosis, would the recent 1q gain have caused Velcade to stop working? Would it cause Kyprolis to not work?
Has anyone been on Pomalyst / Kyprolis / dex? Have you had luck with quick responses? Bear in mind that we only have one to two months until transplant, and I believe it is desirable to have some sort of response prior.
Does anyone have t(4;14) with 1q gain? Have proteasome inhibitors worked for you?
Thank you!!
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BeatMyeloma - Name: BeatMyeloma
- Who do you know with myeloma?: My mother
- When were you/they diagnosed?: Jan. 2008
- Age at diagnosis: 54
Re: t(4;14) and 1q gain - implications?
Hi Beatmyeloma,
You've asked several different questions in your posting about different subjects -- e.g., the impact of different chromosomal abnormalities on treatment response, experiences with a specific treatment, etc.. You may want to consider splitting your questions across different postings and also being very clear about what you're asking. In my experience reading the forum regularly, the postings that often go unanswered, or don't get a lot of feedback, are the ones that are unclear about what they're asking or include a lot of different questions.
As far as the combination of Pomalyst, Kyprolis, and dex is concerned, it's a very effective three-drug regimen. There was a presentation about it at the 2013 ASH annual meeting. The regimen was tested in patients who had been heavily pretreated, and it got a very high response rate:
JJ Shah et al, "Phase I/II Dose Expansion Of a Multi-Center Trial Of Carfilzomib and pomalidomide With Dexamethasone (Car-Pom-d) In Patients With Relapsed/Refractory Multiple Myeloma," ASH 2013 Annual Meeting abstract 690
The abstract and slide deck also have information on how patients with different chromosomal abnormalities responded to the combination.
You've asked several different questions in your posting about different subjects -- e.g., the impact of different chromosomal abnormalities on treatment response, experiences with a specific treatment, etc.. You may want to consider splitting your questions across different postings and also being very clear about what you're asking. In my experience reading the forum regularly, the postings that often go unanswered, or don't get a lot of feedback, are the ones that are unclear about what they're asking or include a lot of different questions.
As far as the combination of Pomalyst, Kyprolis, and dex is concerned, it's a very effective three-drug regimen. There was a presentation about it at the 2013 ASH annual meeting. The regimen was tested in patients who had been heavily pretreated, and it got a very high response rate:
JJ Shah et al, "Phase I/II Dose Expansion Of a Multi-Center Trial Of Carfilzomib and pomalidomide With Dexamethasone (Car-Pom-d) In Patients With Relapsed/Refractory Multiple Myeloma," ASH 2013 Annual Meeting abstract 690
The abstract and slide deck also have information on how patients with different chromosomal abnormalities responded to the combination.
Re: t(4;14) and 1q gain - implications?
Just trying to give the big picture! 
But I'll re-write to get some opinions.
But I'll re-write to get some opinions.-
BeatMyeloma - Name: BeatMyeloma
- Who do you know with myeloma?: My mother
- When were you/they diagnosed?: Jan. 2008
- Age at diagnosis: 54
Re: t(4;14) and 1q gain - implications?
OK, can't figure out how to edit. So to simplify.
First, is it possible for 4;14 to develop later in the disease? I ask since my mother had a great result with her first auto transplant. If it has been there since diagnosis, maybe her second SCT will work again?
Second, does the recent 1q gain negate the positive response of 4;14 to proteasome inhibitors; e.g., will Kyprolis have any effect?
First, is it possible for 4;14 to develop later in the disease? I ask since my mother had a great result with her first auto transplant. If it has been there since diagnosis, maybe her second SCT will work again?
Second, does the recent 1q gain negate the positive response of 4;14 to proteasome inhibitors; e.g., will Kyprolis have any effect?
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BeatMyeloma - Name: BeatMyeloma
- Who do you know with myeloma?: My mother
- When were you/they diagnosed?: Jan. 2008
- Age at diagnosis: 54
Re: t(4;14) and 1q gain - implications?
Hi Beat Myeloma,
Can I ask how your mother responded to Kyprolis? It sounds like our situations are similar, as my mom is also t(4;14), 1q (diagnosed with smoldering in 2008, untreated until now).
Thanks so much.
Can I ask how your mother responded to Kyprolis? It sounds like our situations are similar, as my mom is also t(4;14), 1q (diagnosed with smoldering in 2008, untreated until now).
Thanks so much.
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