I am newly diagnosed with IgM multiple myeloma. My bone marrow is clear and my bones have no lesions. I am Canadian, but went to Dana Farber for a second opinion. They recommended treatment with CyBorD (Velcade, cyclophosphamide, and dexamethasone). However, as I am too old (77) for a stem cell transplant, the Ontario Health Plan will only cover Velcade, melphalan, and prednisone (VMP), which I gather is similar.
Does anyone know how VMP and CyBorD compare in effectiveness and survival?
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Blueboar - Name: Jane
- Who do you know with myeloma?: me
- When were you/they diagnosed?: 17 November 2017
- Age at diagnosis: 77
Re: Velcade, melphalan & prednisone (VMP) vs. CyBorD
Hi Jane,
This paper does a comparison of trial results for different Velcade-based treatment regimens for multiple myeloma:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597231/
There are results for both VMP and for CyBorD / VCD.
My initial guess is that CyBorD would be somewhat more effective, and less likely to cause very low blood counts, but I would really check the data to confirm those suspicions. Obviously, I would also check with your specialists to find out what they say (please let us know what youlearn).
The dosing of Velcade has changed over time, so older trial results are not always representative of what you're likely to experience these days. In the past, Velcade dosing was more frequent, often twice a week versus once a week, and it was done intravenously rather than the now more common subcutaneous dosing. The change in dosing has lowered the incidence of peripheral neuropathy associated with Velcade, but some would say it also has lowered a bit the efficacy of Velcade-based regimens.
If you can appeal the requirement that you treated with VMP versus CyBorD, it may be worth knowing that the cost of the two regimens shouldn't be too different. I believe Velcade is now generic in Canada, as are all other drugs in the two regimens, so the cost difference between the regimens probably is not that big. That could affect how likely you are to get approval on an appeal to switch to CyBorD.
One thing I don't know is how the fact that you have IgM multiple myeloma, rather than the more common IgG or IgA multiple myeloma, fits into the treatment recommendation you received. You may want to dig into the literature about IgM multiple myeloma to see if there is anything on that issue.
Cheers!
This paper does a comparison of trial results for different Velcade-based treatment regimens for multiple myeloma:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597231/
There are results for both VMP and for CyBorD / VCD.
My initial guess is that CyBorD would be somewhat more effective, and less likely to cause very low blood counts, but I would really check the data to confirm those suspicions. Obviously, I would also check with your specialists to find out what they say (please let us know what youlearn).
The dosing of Velcade has changed over time, so older trial results are not always representative of what you're likely to experience these days. In the past, Velcade dosing was more frequent, often twice a week versus once a week, and it was done intravenously rather than the now more common subcutaneous dosing. The change in dosing has lowered the incidence of peripheral neuropathy associated with Velcade, but some would say it also has lowered a bit the efficacy of Velcade-based regimens.
If you can appeal the requirement that you treated with VMP versus CyBorD, it may be worth knowing that the cost of the two regimens shouldn't be too different. I believe Velcade is now generic in Canada, as are all other drugs in the two regimens, so the cost difference between the regimens probably is not that big. That could affect how likely you are to get approval on an appeal to switch to CyBorD.
One thing I don't know is how the fact that you have IgM multiple myeloma, rather than the more common IgG or IgA multiple myeloma, fits into the treatment recommendation you received. You may want to dig into the literature about IgM multiple myeloma to see if there is anything on that issue.
Cheers!
Re: Velcade, melphalan & prednisone (VMP) vs. CyBorD
Hello Jane and welcome to the forum.
I am sorry to hear that you have developed myeloma, but it seems that you are researching your options, which can only help!
I thought that the scientific article that Ian posted was very informative. The combinations of VMP and CyBorD are both 'proteasome inhibitor; alkylation; and corticosteroid' types of treatment. I read in the article that melphalan is not used on 'transplant eligible' patients since it may inhibit the collection of stem cells. Melphalan is the same alkylator that is used in stem cell transplants, although I am sure that the dose in VMP would be much less than in an autologous stem cell transplant.
If your bone marrow is clear, does this mean that you have not been able to be tested for chromosomal deletions? This information can determine whether or not a patient is 'high risk', which makes a difference in treatments sometimes.
One problem in the province of Ontario is that bortezomib is not prescribed 'twice', at least for transplant eligible patients.
Have you been referred to one of the myeloma specialists in your province, such as at the Princess Margaret Hospital? I live in Alberta and am at a centre with myeloma specialists. I understand that in your province, which has many cancer centres, there is a referral process for a patient such as yourself to get an expert opinion. And also, you might be able to get onto a clinical trial too, or gain 'special access' to a new drug such as carfilzomib (Kyprolis), which is not funded yet by the provinces.
Hope that helps and please let us know what you find out!
I am sorry to hear that you have developed myeloma, but it seems that you are researching your options, which can only help!
I thought that the scientific article that Ian posted was very informative. The combinations of VMP and CyBorD are both 'proteasome inhibitor; alkylation; and corticosteroid' types of treatment. I read in the article that melphalan is not used on 'transplant eligible' patients since it may inhibit the collection of stem cells. Melphalan is the same alkylator that is used in stem cell transplants, although I am sure that the dose in VMP would be much less than in an autologous stem cell transplant.
If your bone marrow is clear, does this mean that you have not been able to be tested for chromosomal deletions? This information can determine whether or not a patient is 'high risk', which makes a difference in treatments sometimes.
One problem in the province of Ontario is that bortezomib is not prescribed 'twice', at least for transplant eligible patients.
Have you been referred to one of the myeloma specialists in your province, such as at the Princess Margaret Hospital? I live in Alberta and am at a centre with myeloma specialists. I understand that in your province, which has many cancer centres, there is a referral process for a patient such as yourself to get an expert opinion. And also, you might be able to get onto a clinical trial too, or gain 'special access' to a new drug such as carfilzomib (Kyprolis), which is not funded yet by the provinces.
Hope that helps and please let us know what you find out!
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
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