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Light chain myeloma & bortezomib (Velcade)
DFCI Physicians: I have read that patients with light chain myeloma often (but not always) have particularly excellent responses to bortezomib--especially when combined with dexamethasone and/or cyclophosphamide. When used as front-line treatment for a newly diagonosed LCO patient, do these responses tend to be durable? More specifically, how long could one expect her remission to last? (Please assume that baseline characteristics and FISH suggest standard-risk disease.) My deepest thanks.
Re: Light chain myeloma & bortezomib (Velcade)
Dr. Paul Richardson from the Dana-Farber Cancer Institute said:
"Light chain multiple myeloma is indeed more responsive to Velcade (bortezomib) based therapy. In combination in particular, these responses can be very durable.
However, we have also seen prolonged responses to bortezomib monotherapy in patients with light chain disease."
"Light chain multiple myeloma is indeed more responsive to Velcade (bortezomib) based therapy. In combination in particular, these responses can be very durable.
However, we have also seen prolonged responses to bortezomib monotherapy in patients with light chain disease."
Re: Light chain myeloma & bortezomib (Velcade)
With kidney failure in addition to light chain myeloma, is Velcade still recommended? I would also be interested in knowing more about what type of response I might expect from Velcade therapy.
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sfisher
Re: Light chain myeloma & bortezomib (Velcade)
Dr. Martha Lacy from the Mayo Clinic said:
"You are correct that there are articles that show impressive response rates with Velcade (bortezomib) when combined with cyclophosphamide and dexamethasone (aka CVD or CyBorD). Not only are response rates high but responses occur rapidly with this combination.
Your question about the durability of responses is a good one but is hard to answer. The duration of response is determined by biology (with high risk and standard risk groups determined by genetic and molecular markers in the malignant plasma cells) as well as the clinical situation. Patients with newly diagnosed untreated myeloma would be expected to have longer remission duration than patients receiving this regimen after 6 or 8 previous chemotherapies.
There are a number of anecdotes and case reports regarding the usefulness of Velcade, alone or in combination with other drugs, in LCO myeloma. Velcade is attractive for this group because LCO patients are at higher risk of having kidney complications from multiple myeloma, and Velcade can be given safely even in kidney failure.
However, data regarding the best treatment specifically for the LCO subgroup are hard to find. Myeloma trials are rarely, if ever, designed to include only LCO patients and this subgroup is rarely reported separately in most publications. Your best option is to discuss your unique situation with your doctor to determine the regimen that is best for you."
"You are correct that there are articles that show impressive response rates with Velcade (bortezomib) when combined with cyclophosphamide and dexamethasone (aka CVD or CyBorD). Not only are response rates high but responses occur rapidly with this combination.
Your question about the durability of responses is a good one but is hard to answer. The duration of response is determined by biology (with high risk and standard risk groups determined by genetic and molecular markers in the malignant plasma cells) as well as the clinical situation. Patients with newly diagnosed untreated myeloma would be expected to have longer remission duration than patients receiving this regimen after 6 or 8 previous chemotherapies.
There are a number of anecdotes and case reports regarding the usefulness of Velcade, alone or in combination with other drugs, in LCO myeloma. Velcade is attractive for this group because LCO patients are at higher risk of having kidney complications from multiple myeloma, and Velcade can be given safely even in kidney failure.
However, data regarding the best treatment specifically for the LCO subgroup are hard to find. Myeloma trials are rarely, if ever, designed to include only LCO patients and this subgroup is rarely reported separately in most publications. Your best option is to discuss your unique situation with your doctor to determine the regimen that is best for you."
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