My mother has been on a Revlimid, Velcade, and dexamethasone regimen since January due to a high kappa-lambda ratio.
She took Velcade (2 mg), dexamethasone (40 mg) on day 1 along with 10 mg Revlimid for 15 days and then a break of 15 days.
In February her ratio was 67 with a kappa value at 850, and now her ratio rose to 95 with a kappa value at 1095.
She had been treated with Velcade twice before when her ratio was high, and that brought the ratio to normal, but in that case Velcade was given weekly for 6 cycles. This time she was given Velcade once a month and since last the 2 months she did not take Revlimid due to low blood counts. In the 5th month she got 8 mg dexamethasone and 6th month she got 20 mg dexamethasone instead of 40 mg due to low counts.
My question is does this mean she has stopped responding to Velcade, or could this be due to monthly Velcade instead of weekly. Does Velcade's dosing affect its efficacy?
Any replies are appreciated.
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Re: Does Velcade's dose affect its effectiveness?
Hello Ruchi,
There has been some research that shows that reducing the frequency of Velcade dosing from, say, twice a week to once a week during induction therapy does not have much of an effect on the drug's efficacy. At some point, though, reducing the dose is going to have an effect on efficacy. Otherwise, what's the point of more frequent dosing?
It sounds like the drug doses your mother was on were more like maintenance-type doses (less frequent Velcade, lower-dose and less-frequent Revlimid, etc.). I suspect her doctors at this point would like to increase her Velcade dose / frequency to get her disease under better control, but they are concerned that doing so would drive her blood cell counts even lower.
Have the doctors actually discussed increasing the frequency of your mother's Velcade dose while keeping her off of the Revlimid? Or perhaps switching her from Velcade-only to Revlimid-only (plus dex in both cases)?
I'm sorry about the challenges your mother is facing. Good luck to both of you.
There has been some research that shows that reducing the frequency of Velcade dosing from, say, twice a week to once a week during induction therapy does not have much of an effect on the drug's efficacy. At some point, though, reducing the dose is going to have an effect on efficacy. Otherwise, what's the point of more frequent dosing?
It sounds like the drug doses your mother was on were more like maintenance-type doses (less frequent Velcade, lower-dose and less-frequent Revlimid, etc.). I suspect her doctors at this point would like to increase her Velcade dose / frequency to get her disease under better control, but they are concerned that doing so would drive her blood cell counts even lower.
Have the doctors actually discussed increasing the frequency of your mother's Velcade dose while keeping her off of the Revlimid? Or perhaps switching her from Velcade-only to Revlimid-only (plus dex in both cases)?
I'm sorry about the challenges your mother is facing. Good luck to both of you.
Re: Does Velcade's dose affect its effectiveness?
Hi Ian,
Thank you so much for your reply.
My mother just had been to her oncologist and he isn't much concerned about the ratio. He stopped Revlimid and now will have her take Velcade on day 1 with 20 mg dexamethasone, then 20 mg dexamethasone again on day 2 and day 3, and then after 3 weeks will repeat the same cycle. He will test her ratio after 2 cycles and then decide on further treatment.
He thinks the ratio increased due to residual disease (not sure what that exactly means) and that the Velcade is working.
Her kidney tests are normal, B2 microglobulin decreased from 5600 to 3900ng/ml after 6 cycles of Velcade.
IgG is 865 mg/dl
IgM is 21 mg/dl
IgA is 109 mg/dl
Hemoglobin is 10.8
Platelets are 220000
WBC are 3800.
She has never had an M-spike as she has nonsecretory disease measured by light chains only. He thinks all above values look good, so the ratio might have been high due to residual disease.
Now will wait for next test results after cycle 2 and see how the ratio looks.
Thank you so much for your reply.
My mother just had been to her oncologist and he isn't much concerned about the ratio. He stopped Revlimid and now will have her take Velcade on day 1 with 20 mg dexamethasone, then 20 mg dexamethasone again on day 2 and day 3, and then after 3 weeks will repeat the same cycle. He will test her ratio after 2 cycles and then decide on further treatment.
He thinks the ratio increased due to residual disease (not sure what that exactly means) and that the Velcade is working.
Her kidney tests are normal, B2 microglobulin decreased from 5600 to 3900ng/ml after 6 cycles of Velcade.
IgG is 865 mg/dl
IgM is 21 mg/dl
IgA is 109 mg/dl
Hemoglobin is 10.8
Platelets are 220000
WBC are 3800.
She has never had an M-spike as she has nonsecretory disease measured by light chains only. He thinks all above values look good, so the ratio might have been high due to residual disease.
Now will wait for next test results after cycle 2 and see how the ratio looks.
Re: Does Velcade's dose affect its effectiveness?
Hi Ruchi,
Your mother's doctor knows your mother's case the best, so I would be encouraged by the fact that he feels the Velcade will keep her free light chain levels from getting out of control. Let us know how she does.
I think most specialists these days, by the way, would describe your mother's myeloma as "light chain multiple myeloma", not "nonsecretory multiple myeloma". Strictly speaking, nonsecretory means that a patient has neither an M-spike nor elevated free light chain levels. A strictly nonsecretory patient's myeloma is not secreting either monoclonal immunoglobulins (IgG, IgA, IgM, etc.) or monoclonal free light chains.
Your mother's doctor knows your mother's case the best, so I would be encouraged by the fact that he feels the Velcade will keep her free light chain levels from getting out of control. Let us know how she does.
I think most specialists these days, by the way, would describe your mother's myeloma as "light chain multiple myeloma", not "nonsecretory multiple myeloma". Strictly speaking, nonsecretory means that a patient has neither an M-spike nor elevated free light chain levels. A strictly nonsecretory patient's myeloma is not secreting either monoclonal immunoglobulins (IgG, IgA, IgM, etc.) or monoclonal free light chains.
Re: Does Velcade's dose affect its effectiveness?
I also hope that the Velcade is still working. I will update with her future test results.
Thanks for the information regarding secretory and nonsecretory disease. When my mother was diagnosed in 2011, it was nonsecretory solitary plasmacytoma of right femur bone, so I was under the impression it might be due to absence of M-spike.
Thanks for the information regarding secretory and nonsecretory disease. When my mother was diagnosed in 2011, it was nonsecretory solitary plasmacytoma of right femur bone, so I was under the impression it might be due to absence of M-spike.
Re: Does Velcade's dose affect its effectiveness?
Just an update to my mother's result after increasing her dexamethasone dosage to 60 mg per 3-week cycle. Her kappa-lambda ratio dropped to 45 in September and then to 21 in December. But in February 2018 it again rose to 35.
Her oncologist has now increased the dexamethasone dose to 80 mg (20 mg each from day 1 to 4), and added back Revlimid 10 mg for 15 days. We will re-test the ratio again after 2 cycles.
Her oncologist has now increased the dexamethasone dose to 80 mg (20 mg each from day 1 to 4), and added back Revlimid 10 mg for 15 days. We will re-test the ratio again after 2 cycles.
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