[p_roy]

Treatment stopped because of severely low platelets

by p_roy on Thu Jun 20, 2013 6:54 am

Hi,

My father was diagnosed with multiple myeloma in October, 2009 - stage 2. His doctors decided that he was not a good candidate for a transplant because of various other problems he already had (angioplasty and moderate stroke) . He was put on dex and Velcade right away. But he developed pneumonia and the doctor urged us to get him to a better hospital, which we did. He got better and February, 2010 started his treatment under another hematologist. He got better and even achieved partial remission all through 2010-2011.

Fast forward to 2012 and he got worse. The multiple myeloma came back and brought friends. He developed cataracts in both eyes because of the dex and now has large pericardial effusion in his heart. Because of his low platelet count (around 30000), draining the fluid has been ruled out for the time being and he has been put on antibiotic for the tuberculosis that the doctors are not even sure he has.

Anyway, the doctor decided to continue his treatment according to the VMP (Velcade, melphalan, prednison) protocol. But last week, after only one dose of Velcade (delivered after transfusion with 1 unit of single-donor platelet), his platelet has now dropped to 8,000. So on this Tuesday, he was given another SDP transfusion and his treatment has been stopped.

He has been placed on 40 mg of dex every Sunday to try and bring back his platelet count and the doctor also did a bone marrow biopsy (still waiting for the results). But what has caused me to lose hope is that the doctor for the first time in 4 years has just confessed to me that my father is not doing well at all.

Can anyone give me some advice on what else we can do?

[p_roy]

Re: Treatment stopped because of severely low platelets

by p_roy on Sat Aug 03, 2013 7:20 am

I made a post earlier that my father's treatment (Velcade, melphalan and prednisolone) for refractory multiple myeloma (diagnosed in 2009) because of severely low platelets. Now after several SDP and RDP transfusions and weekly dex (40 mg), his platelet is 24,000. For three weeks, it has been around that number.

He is also receiving weekly Epogen (40,000). His hemoglobin is 9.6 and WBC is 3600.

Now his doctor says it's time to try something drastic because Dad is running out of time. Without treatment, he has been given months to live. The doctor wants to try 50 mg of melphalan IV once a month. He has already warned us that all the blood components will drop and asked us to be ready for it.

Is it necessary to give such a high dose of melphalan? Isn't there anything else we can try? And if melphalan is given, what are the side effects that he'll have to deal with.

I will be very grateful for any advice. Thanks.

[tpt]

Re: Treatment stopped because of severely low platelets

by tpt on Sat Aug 03, 2013 9:59 am

I'm sorry for your difficulties. I'm very certain that a lot of readers are very concerned with your situation; but this is a very specific question that one cannot easily answer or comment. Please be strong and stay positive.

[Dr. Ken Shain]

Re: Treatment stopped because of severely low platelets

by Dr. Ken Shain on Sun Aug 04, 2013 10:22 am

I am sorry to hear that the myeloma and/or therapy is giving your father such a difficult time. As the previous post suggests, it is very difficult to make specific suggestions based on the information in the post. However, once the disaese becomes poorly responsive to therapy and myelosuppression (whether disease related or secondary to the accumulation of therapy) treatment options become limited.

I do not know where you reside (or your father), but has he tried Revlimid (lenalidomide), Pomalyst (pomalidomide), or Kyprolis (carfilzomib) based regimens? These may or may not all be available to you. Obviously, your father's overall performance status and other comorbidities are important to take into account whenever considering different regimens of therapy. There are other options, as well, including Cytoxan (cyclophosphamide), Treanda (Bendamustine) based therapies; however, therapy has to be put in the context of the patients overall ability to tolerate therapy and goals of therapy. With myelosuppression (low blood counts), transfusions will be necessary for sure. Also, prophylactic antibiotics should be utilized, as I am sure that his white count is also low and going to be lower.

We all wish you and your family the best of luck.

[ritu]

Re: Treatment stopped because of severely low platelets

by ritu on Thu Aug 06, 2015 6:17 am

My mother too had the issue of low platelets in myeloma. She is undergoing transfusion today. Please can let know how long she will have to wait for next chemo session?

[joe]

Re: Treatment stopped because of severely low platelets

by joe on Fri Nov 06, 2015 5:28 pm

I am so sorry that this is not going well. How about transfusion to raise platelets? Also, I am on a trial drug that is doing good things for me. I am on Revlimid and dexamethasone and the trial drug is panobinostat (Farydak). It has done very well for me.

Best of look to you.