[asaryden]

Time to response to rev/dex?

by asaryden on Mon Jul 09, 2012 6:39 am

I have just started treatment with Revlimid and dex in order to try and lower my lamda light chains before an allogenic transplantation. My question is how long it takes before you can say it hasen´t got any effect?
My lamda light chains (in urin collection for 24H) were 80 the day before I started treatment with Rev/dex. After 1 week lambda light chains were 600! One doctor told me that you usually get a result during the first days and another doctor said it takes at least 2-3 weeks (and he is in charge of my treatment).
When I started my induction therapy before ASCT back in 2010, I was given thalidomid, cyclofosfamide and dex. At that time we also tried to evaluate treatment after one week and my numbers went up but the doctor said you can´t tell after just one week. There was no resonse after 3 weeks either and it was concluded that I was refractory to CTD. I went on to VCD and it had an amazing effect, from 18000 to 460 in just 1 cycle.
What are the doctors at The Myeloma beacon and other patients experience of this?
I´ve used Velcade as maintenance treatment for a year and the numbers have been increasing slowly during spring. But now there was a big jump in numbers. I am concerned.

[Dr. Ken Shain]

Re: Time to response to rev/dex?

by Dr. Ken Shain on Tue Jul 10, 2012 6:57 pm

I think that 3 and especially one week is a bit of stretch to call therapy a failure. Progression through therapy is definitely not a good sign for successful therapy. Stable disease is defined by a decrease or increase in paraprotein by less that 25%. As such, progression is an increase by more than 25% (at the end of a cycle- not mid-cycle). A minor response is a decrease in monoclonal paraprotein by 25-50%.

However, for Rev/dex 1-3 months/cycles as they are 28 day cycles (even longer in some cases) is a reasonable period to expect as response. I generally use 2 cycles or two months before I consider adding an additional agent or altering therapy. In the MM010 clinical trial one of the phase III trials leading to the approval of Rev in the relapsed refractory setting the median time to first response was 2.1 months- so a little over a month.

We will keep our fingers crossed.

[asaryden]

Re: Time to response to rev/dex?

by asaryden on Fri Jul 20, 2012 9:43 am

Thank you for your answer.
I did get some good results today that my numbers are down to 43 (after 3 weeks treatment). So i did definitely worry too much. Well that´s me!