Hi, I need advice for the choice of next line of therapy for my mother. She is 72 years old and has IgG lambda hi risk [ t(4,14) +1q21] myeloma.
A little summary of the clinical story:
After two cycle of Revlimid-dexamethasone, discontinued because an intestinal stroke that lead to a removal surgery and the inefficacy of the Revlimid-dex,at the beginning a mild response, but before the surgery, a little progression, best results:only achieve stable disease.
After she recovery from the surgery undergo 3 cycle of Velcade, doxorubicin, dexamethasone and mobilization with cyclophosphamide, she's reached VGPR with non quantificable component.
Then two autologous stem cell transplants with no improvement in the deep of the response.
I try, like I post here before, without success to have Velcade maintenance, but because the drug is not approved in Italy for maintenance even if I pay my self, I was not able to obtain this therapy.
The second ASCT response was lost after only six months,1 year from the first, with an increment of 10g/l (1 g/dL) in the m-spike from the non quantificable of the previous months.
At this point I try to take part at one trial with pomalidomide [Pomalyst, Imnovid] and carfilzomib [Kyprolis], but the physician says that because the adverse event probably caused by lenalidomide, they don't take the risk to enroll my mother in the Phase 1, but if she relapsed / refractory, is possible to have access at the second phase of the study.
I'm really sad about this exclusion. I think this study is really promising for a high risk patient.
Now we have two options.
1. Velcade-dex
2. Velcade-bendamustine (Treanda)-dex
I would choose, if I can, subsequential addition of bendamustine if Velcade-dex doesn't work,
but because of the medical prescription in my country, the choice is now or never.
What should I choose for my mother's disease?
Thank you for any advice.
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