My team at SCCA is considering a course of VRD-PACE prior to my auto-transplant to get my numbers lower (bone marrow plasma cell percentage and serum free light chains). I have already done 6 courses of Velcade and 4 of Revlimid and have been on dex since diagnosis beginning of May.
Has anyone done this treatment? Did you do it early on?
I understand the importance of getting numbers as low as possible prior to transplant, but my concern is limiting later treatment options if I have more drugs now.
Would love your thoughts!
Moderator's Note:
VRD-PACE = Velcade, Revlimid, Dexamethasone - CisPlatin, Adriamycin (doxorubicin), Cyclophoshamide (Cytoxan), and Etoposide.
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CindyBrown - Name: Cindy Brown
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 4/26/14
- Age at diagnosis: 48
Re: VRD-PACE - any experiences with it?
Hi Cindy,
My name is Michelle Gillet, and I am 45 years old. I had VDT-PACE (T= thalidomide, Revlimid's old brother!!) in October 2011 prior to my SCT.
I, like you, had several rounds of Revlimid, Velcade and dex, followed by a few rounds of Cytoxan and also thalidomide. This was all to get my stubborn but not aggressive M-spike lower.
It was this combo that made my hair fall out, but that was really the only side effect I had. I was lucky to not even get nausea or diarrhea.
I had a tandem SCT which eventually got me to remission. I have been in remission and on maintenance for 2 years now.
Please feel free to ask any further questions.
My name is Michelle Gillet, and I am 45 years old. I had VDT-PACE (T= thalidomide, Revlimid's old brother!!) in October 2011 prior to my SCT.
I, like you, had several rounds of Revlimid, Velcade and dex, followed by a few rounds of Cytoxan and also thalidomide. This was all to get my stubborn but not aggressive M-spike lower.
It was this combo that made my hair fall out, but that was really the only side effect I had. I was lucky to not even get nausea or diarrhea.
I had a tandem SCT which eventually got me to remission. I have been in remission and on maintenance for 2 years now.
Please feel free to ask any further questions.
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meeshymeesh - Name: Michelle
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: 2009
- Age at diagnosis: 40
Re: VRD-PACE - any experiences with it?
I made several postings here in the forum about my experience with VD-PACE. The last entry was mid-September.
"Paul's VD-PACE treatment experience," Beacon forum discussion started Sep 11, 2014.
The rationale for doing this was similar to you - in my case, getting plasma cells in BM below 5%. Since those posts, I've gone through stem cell harvest and am scheduled for ASCT next week.
All I would add to my VD-PACE experience is that my hair started falling out about 2 weeks later. I gave up the battle and had it shaved off last week.
"Paul's VD-PACE treatment experience," Beacon forum discussion started Sep 11, 2014.
The rationale for doing this was similar to you - in my case, getting plasma cells in BM below 5%. Since those posts, I've gone through stem cell harvest and am scheduled for ASCT next week.
All I would add to my VD-PACE experience is that my hair started falling out about 2 weeks later. I gave up the battle and had it shaved off last week.
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Villa fan - Name: Paul Gater
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: February 2014
- Age at diagnosis: 56
Re: VRD-PACE - any experiences with it?
Thanks for the responses. They are considering one round to try to get the numbers lower (bone marrow and light chains - I have no m-spike and never have) and another round a month after for further reduction and conditioning for the ASCT. It would be great to only deal with hair loss as a side effect, but I am preparing myself for the GI issues also.
One of the questions that remains is whether or not using more drugs up front limits options on relapse? Like you, Michelle, I am on the younger end of this diagnosis, with 2 of my 5 kids still at home, so I'm especially anxious to have a lot of healthy years in front of me.
One of the questions that remains is whether or not using more drugs up front limits options on relapse? Like you, Michelle, I am on the younger end of this diagnosis, with 2 of my 5 kids still at home, so I'm especially anxious to have a lot of healthy years in front of me.
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CindyBrown - Name: Cindy Brown
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 4/26/14
- Age at diagnosis: 48
Re: VRD-PACE - any experiences with it?
I went through VDT-PACE -- three rounds in 2012 and two rounds over the last 3 months for plasma cell leukemia, an aggressive form of multiple myeloma. Yes my hair fell out both times, but it certainly worked to eliminate the disease before my auto transplant in February, 2013. We are hoping that I will have a complete response after this course of chemo too. I will find out next week.
Had a BMB yesterday to see if there is any myeloma remaining. I now need to get an allogeneic transplant, since my remission only lasted 18 months. I do suffer with lots of nausea, but my medicines pretty much control it just fine. Fatigue is par for any course of chemo, so I take lots of naps.
I hope that your VRD-PACE treatment gives you a complete response and you will be ready for ASCT.
Blessings
Had a BMB yesterday to see if there is any myeloma remaining. I now need to get an allogeneic transplant, since my remission only lasted 18 months. I do suffer with lots of nausea, but my medicines pretty much control it just fine. Fatigue is par for any course of chemo, so I take lots of naps.
I hope that your VRD-PACE treatment gives you a complete response and you will be ready for ASCT.
Blessings
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WeatherNurse13 - Name: Gracie
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: 10/2012
- Age at diagnosis: 49
Re: VRD-PACE - any experiences with it?
Dear all,
VRD-PACE is highly effective at reducing myeloma burden, but it does come at a price. It is a heavy hit to the bone marrow. You can expect your white blood cell count and neutrophils to hit zero or very close to it. At that time, you are at increased risk of infection. The use of Neupogen (filgrastim) or Neulasta (pegfilgrastim) will not prevent the white blood cell count from dropping very low, but it will shorten the duration of time that it is low. Prophylactic antibiotics are typically required to further reduce the risk of infection.
Even with these preventative measures in place, you can wind up in the hospital on IV antibiotics if you develop an infection while your white blood cell count is low. It is not uncommon to require 1 or several blood transfusions for anemia. Occasionally, a platelet transfusion or several may also be required. We typically have patients get their blood counts checked frequently during this time.
Gastrointestinal side effects can occur, including loss of appetite and a sensation that nothing tastes right. Diarrhea, mouth sores and vomiting can also occur but are less common than the above mentioned GI side effects.
Fatigue is more significant with this regimen compared to many of the others mentioned in this thread.
The cisplatin can sometimes cause problems with low potassium and magnesium levels, requiring supplements in some instances. This also needs to be monitored carefully.
And yes, the hair starts to fall out 2 to 3 weeks from the start of treatment.
This is a regimen that is easier to handle the younger you are and is most commonly used before transplant in younger patients with highest-risk disease or as salvage therapy for a young patient with relapsed or refractory high-risk disease.
I hope this helps. Best of luck!
Pete V.
VRD-PACE is highly effective at reducing myeloma burden, but it does come at a price. It is a heavy hit to the bone marrow. You can expect your white blood cell count and neutrophils to hit zero or very close to it. At that time, you are at increased risk of infection. The use of Neupogen (filgrastim) or Neulasta (pegfilgrastim) will not prevent the white blood cell count from dropping very low, but it will shorten the duration of time that it is low. Prophylactic antibiotics are typically required to further reduce the risk of infection.
Even with these preventative measures in place, you can wind up in the hospital on IV antibiotics if you develop an infection while your white blood cell count is low. It is not uncommon to require 1 or several blood transfusions for anemia. Occasionally, a platelet transfusion or several may also be required. We typically have patients get their blood counts checked frequently during this time.
Gastrointestinal side effects can occur, including loss of appetite and a sensation that nothing tastes right. Diarrhea, mouth sores and vomiting can also occur but are less common than the above mentioned GI side effects.
Fatigue is more significant with this regimen compared to many of the others mentioned in this thread.
The cisplatin can sometimes cause problems with low potassium and magnesium levels, requiring supplements in some instances. This also needs to be monitored carefully.
And yes, the hair starts to fall out 2 to 3 weeks from the start of treatment.
This is a regimen that is easier to handle the younger you are and is most commonly used before transplant in younger patients with highest-risk disease or as salvage therapy for a young patient with relapsed or refractory high-risk disease.
I hope this helps. Best of luck!
Pete V.
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Dr. Peter Voorhees - Name: Peter Voorhees, M.D.
Beacon Medical Advisor
Re: VRD-PACE - any experiences with it?
Thank you, Dr. Vorhees.
I am a younger patient (49), diagnosed in late April, and thought I had responded well to RVD (Revlimid, Velcade, dexamethasone) with plasma cells dropping from 80% to 4% but still high kappa light chains (1500) and no genetic abnormalities on FISH.
When I got to SCCA/Fred Hutchinson the 1st of this month for transplant, they read that last biopsy at 14%, and a repeated biopsy showed 60% plasma cells and rising kappa light chains.
I have been in the hospital since Friday and am on my 4th day of TD-PACE. The nausea is well controlled with regular Zofran, and I am only dealing with appetite loss and food not tasting normal.
My counts have dropped a little today and I expect more when I am discharged tomorrow and in the coming weeks. I am hopeful that this will help with my myeloma burden so I can transplant soon.
I am curious if the use of this regimen now limits my options on relapse (assuming I get some sort of remission)
Thanks,
Cindy
I am a younger patient (49), diagnosed in late April, and thought I had responded well to RVD (Revlimid, Velcade, dexamethasone) with plasma cells dropping from 80% to 4% but still high kappa light chains (1500) and no genetic abnormalities on FISH.
When I got to SCCA/Fred Hutchinson the 1st of this month for transplant, they read that last biopsy at 14%, and a repeated biopsy showed 60% plasma cells and rising kappa light chains.
I have been in the hospital since Friday and am on my 4th day of TD-PACE. The nausea is well controlled with regular Zofran, and I am only dealing with appetite loss and food not tasting normal.
My counts have dropped a little today and I expect more when I am discharged tomorrow and in the coming weeks. I am hopeful that this will help with my myeloma burden so I can transplant soon.
I am curious if the use of this regimen now limits my options on relapse (assuming I get some sort of remission)
Thanks,
Cindy
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CindyBrown - Name: Cindy Brown
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: 4/26/14
- Age at diagnosis: 48
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