Hello all,
I'm writing on behalf of my father who was recently diagnosed with KLC multiple myeloma.
He is about 60kg (132lbs), and he is currently receiving Velcade via IV, thalidom and dexameth. The dosage of the Velcade is 2.1mg, weekly.
When he was first diagnosed, he had severe compression fracture, and his kappa was on the order of 600. After six cycles of Velcade, his Kappa was 140ish and the KL ratio was 12ish.
Today was our weekly party, so we called the Velcade administration, and the results from last week's freelite test came out. His Kappa jumps to 190ish and hisnKL ratio jumps to 27ish.
My quesion is: do we need a higher dose? Is Kappa the only marker?
Any comments will help. Thanks!
Forums
3 posts
• Page 1 of 1
Re: Velcade dosage
I hope that your father is feeling well. Generally Velcade (bortezomib) can be given at 1.3mg/m2 days 1,4,8,& 11 and we do not dose escalate due to side effects. However, as you are only receiving it weekly there may be room to change to the regimen above -- potentially changing to subcutaneous dosing to minimize the potential for peripheral neuropathy. There is real potential for this regimen as both Velcade and thalidomide can cause peripheral neuropathy. We will dose reduce secondary to side effects however.
I would be careful to not over interpret a single change of light chains from 170 to 190 or even the ratio (which typically is the more appropriate measure of disease). Wait to determine if there is a trend over this next cycle before declaring anything.
In myeloma we use SPEP (serum protein electrophoresis), sIFE (serum immunofixation), UPEP (urine), uIFE, quantitative immunoglobulins, and SFLCs (serum free light chains) to follow patients disease without having do serial biopsies. Some patient's myeloma, however, only produces light chains, in that case only the SFLC can be used as a barometer for disease burden within the bone marrow.
If true questions of progression occurs it is appropriate to repeat a bone marrow biopsy to determine the level of marrow involvement, but that too is imperfect. However, it is a way to gather the most information to make the best decision.
I would be careful to not over interpret a single change of light chains from 170 to 190 or even the ratio (which typically is the more appropriate measure of disease). Wait to determine if there is a trend over this next cycle before declaring anything.
In myeloma we use SPEP (serum protein electrophoresis), sIFE (serum immunofixation), UPEP (urine), uIFE, quantitative immunoglobulins, and SFLCs (serum free light chains) to follow patients disease without having do serial biopsies. Some patient's myeloma, however, only produces light chains, in that case only the SFLC can be used as a barometer for disease burden within the bone marrow.
If true questions of progression occurs it is appropriate to repeat a bone marrow biopsy to determine the level of marrow involvement, but that too is imperfect. However, it is a way to gather the most information to make the best decision.
-
Dr. Ken Shain - Name: Ken Shain, M.D., Ph.D.
Beacon Medical Advisor
Re: Velcade dosage
Thank you for your reply.
His other immunoglobins are generally normal or lower than the normal range. Only his Kappa light chain that is elevated.
We are on our sixth cycle but we see only steady level of KLC, around 120-190, but it never goes down below 100. We are getting worried if he does not respond well to Velcade. Moreover, he has p53 deletion, which is not a good trait.
We have to go to Singapore for the injection, which make it even harder for us. We are from Indonesia.
If this regimen does not work, is stem cell transplantation next? Thank you.
His other immunoglobins are generally normal or lower than the normal range. Only his Kappa light chain that is elevated.
We are on our sixth cycle but we see only steady level of KLC, around 120-190, but it never goes down below 100. We are getting worried if he does not respond well to Velcade. Moreover, he has p53 deletion, which is not a good trait.
We have to go to Singapore for the injection, which make it even harder for us. We are from Indonesia.
If this regimen does not work, is stem cell transplantation next? Thank you.
3 posts
• Page 1 of 1