Hi,
Well it's time for my husband's next appointment with his oncologist. Last labs two months ago showed a slight M-spike and an increase in kappa light chains. I do realize that this does not mean a lot with regard to relapse and we would be looking for a trend before treatment is started again.
But, with that said, I can't help but wonder what his treatment options will be. Original therapy was Velcade and Cytoxan, both weekly. Unfortunately, this was very damaging to his heart. When we did a work up for stem cell collection at Mayo, they found his ejection fraction was down to 29 percent. He was not a candidate for collection or transplant at that point. He now has an ejection fraction of 40 percent, which is an improvement, but not fabulous.
These drugs all seem to have such serious cardiac side effects I can't help but wonder what they will do to him when and if treatment needs to start again.
Any thoughts on a treatment protocol that is "easier" on the heart?
Forums
3 posts
• Page 1 of 1
Re: Treatment options at relapse
Hello Cindy:
Sorry to hear about your husband's heart problems.
A couple of quick thoughts: There is an outside chance that your husband could go on RVD (Revlimid, Velcade, dex). The old Msmart held back RVD for first relapse. If it was the Cytoxan that caused the heart problems, but not the Velcade, then that would potentially be available.
Very generally, I am guessing the Kyprolis would not be a prime candidate. The cardiac side effects I think are in the 4% to 8% range. In some cases, they are mild and reversible, but in rare cases can be severe.
The new Msmart guidelines include elotuzumab-Rev-dex at first relapse in some cases. That would work as long as your husband could tolerate the Rev. For elotuzumab, I do not think that there have been any cardiac side effects. One thing to keep in mind for elotuzumab and daratumumab is that they are so new, there might be some side effects that have not yet even revealed themselves.
Lastly, although I am not experienced in details, I know that there are diet exercise programs for cardiac patients. Some patients do quite well after severe cardiac problems with these exercise programs. Perhaps your husband can get the ejection fraction up a bit higher so when it's time to start the next treatment (which I hope will be a long while) he will tolerate it better.
Good luck to you both.
Sorry to hear about your husband's heart problems.
A couple of quick thoughts: There is an outside chance that your husband could go on RVD (Revlimid, Velcade, dex). The old Msmart held back RVD for first relapse. If it was the Cytoxan that caused the heart problems, but not the Velcade, then that would potentially be available.
Very generally, I am guessing the Kyprolis would not be a prime candidate. The cardiac side effects I think are in the 4% to 8% range. In some cases, they are mild and reversible, but in rare cases can be severe.
The new Msmart guidelines include elotuzumab-Rev-dex at first relapse in some cases. That would work as long as your husband could tolerate the Rev. For elotuzumab, I do not think that there have been any cardiac side effects. One thing to keep in mind for elotuzumab and daratumumab is that they are so new, there might be some side effects that have not yet even revealed themselves.
Lastly, although I am not experienced in details, I know that there are diet exercise programs for cardiac patients. Some patients do quite well after severe cardiac problems with these exercise programs. Perhaps your husband can get the ejection fraction up a bit higher so when it's time to start the next treatment (which I hope will be a long while) he will tolerate it better.
Good luck to you both.
-
JPC - Name: JPC
Re: Treatment options at relapse
Thank you for your reply, I'm pretty late getting back to this. Its possible that his ejection fraction has come up a bit more by this point. He has recently been a little more active. When he was worked up for possible transplant or even just stem cell collection, he was not a candidate because his ejection fraction was at 29 percent. So it has improved since 2014. And he also had some medication adjustments last spring which could have also improved his heart condition. We are currently watching his M-spike trend upward. He had no M-spike since late 2013, it is now at .2 and was at .1 2 months ago. Other labs are also showing changes, so unfortunately, I think we are looking at relapse here shortly. I know I've read here that its the trend they are looking for, and would not restart treatment until he gets a bit higher?We went thru quite a lot at diagnosis, have no desire to let things get out of hand again.
3 posts
• Page 1 of 1