[Mary Ellen]

Velcade & Cytoxan as relapse therapy?

by Mary Ellen on Sun Dec 11, 2011 3:15 pm

I am wondering if anyone has experience with treatment of multiple myeloma with Velcade and cytoxan.

My brother has been on Revlimid and decadron for 3+ years and has been in remission. His current bloodwork is showing that the Revlimid is no longer working and he has relapsed.

He had his first injection of Velcade 3 days ago and is now taking cytoxan daily by mouth.Any information and reactions would be appreciated.

Good luck and prayers to all.

[Dr. Edward Libby]

Re: Velcade & Cytoxan as relapse therapy?

by Dr. Edward Libby on Mon Dec 12, 2011 1:56 pm

In a study of Velcade, cyclophosphamide and prednisone in relapsed patients (Reece,D -Journal Clinical Oncology 2008: 26:4777-4783) the most common side effects were peripheral neuropathy and thrombocytopenia. These side effects were manageable, reversible, and not dose-limiting. In this study when the Velcade adminstration was changed from twice per week to once per week (intravenous administration) myelosuppression (low blood counts) was milder with less thrombocytopenia and no significant peripheral neuropathy or neuropathic pain was observed. Twice weekly subcutaneous administration will probably have a similar improvement in neuropathy.
Infectious complications were also described including zoster (shingles) occurred in a significant proportion (30%) in patients who did not get antiviral prophylaxis.It is imperative that patients receiving Velcade be gettinbg acyclovir or valacyclovir to prevent zoster (shingles). My experience treating patients with this combination is that the majority tolerate it quite well and with a minimum of extra supportive care or complications.