I am doing great on the new treatment of Velcade. My numbers have dropped amazingly in only 4 shots.
The only thing is my platelets are continuing to drop. I started out at something like 234 thousand/ul, which was great, then it went to 185 thousand/UL , then 156 thousand/UL, and this week its 151 thousand/UL.
Low normal is 140 thousand /UL. So I'm still above, but my question is will it continue to drop or does it stabilize after x amount of treatments.
Does anyone have any experience with this? If it were to keep dropping, what would that mean.?
Everything else on my CBC is great.
Thanks for any input.
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Re: Velcade and platelet levels
Hi Christina,
You might find this article to be insightful. If you aren't up for reading the whole thing, just skip to Figures 2 and 3 and the discussion section at the end.
Lonial, S, et al, "Risk factors and kinetics of thrombocytopenia associated with bortezomib for relapsed, refractory multiple myeloma," Blood 2005 (full text of article)
Abstract:
Bortezomib, a proteasome inhibitor with efficacy in multiple myeloma, is associated with thrombocytopenia, the cause and kinetics of which are different from those of standard cytotoxic agents. We assessed the frequency, kinetics, and mechanism of thrombocytopenia following treatment with bortezomib 1.3 mg/m2 in 228 patients with relapsed and/or refractory myeloma in 2 phase 2 trials. The mean platelet count decreased by approximately 60% during treatment but recovered rapidly between treatments in a cyclic fashion. Among responders, the pretreatment platelet count increased significantly during subsequent cycles of therapy. The mean percent reduction in platelets was independent of baseline platelet count, M-protein concentration, and marrow plasmacytosis. Plasma thrombopoietin levels inversely correlated with platelet count. Murine studies demonstrated a reduction in peripheral platelet count following a single bortezomib dose without negative effects on megakaryocytic cellularity, ploidy, or morphology. These data suggest that bortezomib-induced thrombocytopenia is due to a reversible effect on megakaryocytic function rather than a direct cytotoxic effect on megakaryocytes or their progenitors. The exact mechanism underlying bortezomib-induced thrombocytopenia remains unknown but it is unlikely to be related to marrow injury or decreased thrombopoietin production.
You might find this article to be insightful. If you aren't up for reading the whole thing, just skip to Figures 2 and 3 and the discussion section at the end.
Lonial, S, et al, "Risk factors and kinetics of thrombocytopenia associated with bortezomib for relapsed, refractory multiple myeloma," Blood 2005 (full text of article)
Abstract:
Bortezomib, a proteasome inhibitor with efficacy in multiple myeloma, is associated with thrombocytopenia, the cause and kinetics of which are different from those of standard cytotoxic agents. We assessed the frequency, kinetics, and mechanism of thrombocytopenia following treatment with bortezomib 1.3 mg/m2 in 228 patients with relapsed and/or refractory myeloma in 2 phase 2 trials. The mean platelet count decreased by approximately 60% during treatment but recovered rapidly between treatments in a cyclic fashion. Among responders, the pretreatment platelet count increased significantly during subsequent cycles of therapy. The mean percent reduction in platelets was independent of baseline platelet count, M-protein concentration, and marrow plasmacytosis. Plasma thrombopoietin levels inversely correlated with platelet count. Murine studies demonstrated a reduction in peripheral platelet count following a single bortezomib dose without negative effects on megakaryocytic cellularity, ploidy, or morphology. These data suggest that bortezomib-induced thrombocytopenia is due to a reversible effect on megakaryocytic function rather than a direct cytotoxic effect on megakaryocytes or their progenitors. The exact mechanism underlying bortezomib-induced thrombocytopenia remains unknown but it is unlikely to be related to marrow injury or decreased thrombopoietin production.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Velcade and platelet levels
My father has multiple myeloma that was detected in February 2017. In test report, no M band detected, Kappa chain was abnormally high and serum albumin was 3.505 g/dl. Treatment started with bortezomib (Velcade) and dexamethasone combination.
So far, his condition has improved continuously. His WBC improved from 2.7 to 5, hemoglobin on 8.2 (fluctuations between 8.0 to 8.6 ).
However, his platelets are decreasing continuously. In February when treatment was started, his platelet level was 225000. After 15 days it was 190000. After 30 days it was 155000. Now it is 96000.
I am wondering whether this will affect his treatment and whether something can be done about it.
So far, his condition has improved continuously. His WBC improved from 2.7 to 5, hemoglobin on 8.2 (fluctuations between 8.0 to 8.6 ).
However, his platelets are decreasing continuously. In February when treatment was started, his platelet level was 225000. After 15 days it was 190000. After 30 days it was 155000. Now it is 96000.
I am wondering whether this will affect his treatment and whether something can be done about it.
Re: Velcade and platelet levels
Hi Christina,
I'm seeing a similar experience to you. I'm doing prednisolone, cyclophosphamide, doxorubicin, and carmustine (PCAB) with Velcade, and my readings have been as low as 29. After each cycle it starts to climb back again, and it hit 97 after cycle two. This is my 3rd cycle, and they have cut out Velcade on day 4, then I will have a blood test on day 8 to see if platelets are ok again for day 8/11. I did have it with platelets around 35 last time mid cycle.
I've relapsed 2 times now after an auto transplant 2 years, so it's also possible the myeloma is affecting the platelet count as well, but I'm not seeing any effects from it - from my reading it affects blood clotting (doesn't), so cuts both external and internal are a problem.
john
I'm seeing a similar experience to you. I'm doing prednisolone, cyclophosphamide, doxorubicin, and carmustine (PCAB) with Velcade, and my readings have been as low as 29. After each cycle it starts to climb back again, and it hit 97 after cycle two. This is my 3rd cycle, and they have cut out Velcade on day 4, then I will have a blood test on day 8 to see if platelets are ok again for day 8/11. I did have it with platelets around 35 last time mid cycle.
I've relapsed 2 times now after an auto transplant 2 years, so it's also possible the myeloma is affecting the platelet count as well, but I'm not seeing any effects from it - from my reading it affects blood clotting (doesn't), so cuts both external and internal are a problem.
john
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JohnHamill - Name: John Hamill
- Who do you know with myeloma?: me
- When were you/they diagnosed?: Jan 2014
- Age at diagnosis: 50
Re: Velcade and platelet levels
The lowest my platelets have been on Velcade were 93. It's a pretty predictable cycle. They recover on the week off and then drop during the weekly shots. After 3 years, the recovery level is not as high as it used to be – maybe 160 – but good enough.
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Janet1520
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