[goldmine848]

What are the odds that I am high risk?

by goldmine848 on Wed Mar 12, 2014 7:39 am

I ask the question that way because we have been unable to get FISH results. This is because when I had my initial bone marrow biopsy they were unable to get fluid. Buy the time the bone marrow biopsy (BMB) was repeated, induction therapy had been so successful that there were no myeloma cells to test. My most recent BMB after transplant also showed no myeloma cells.

So the question for me is: are there any other factors -- response to induction treatment, age at time of diagnosis, m-spike, etc. -- that are predictive of high risk disease? This has an immediate impact since it may suggest what type of post-transplant maintenance therapy to use.

[Dr. Edward Libby]

Re: What are the odds that I am high risk?

by Dr. Edward Libby on Wed Mar 12, 2014 1:05 pm

Hello from sunny Palm Springs ! (I am visiting)

This is a challenge and there is no good answer. First of all the chances in general of having high risk cytogenetics are roughly 20%. Without knowing the cytogenetics I would opt for a bortezomib [Velcade] based induction therapy, as this appears to be advantageous for patients with high risk disease [expecially t(4;14) ]. A stem cell transplant is the standard of care (upfront or at first relapse).

A key question would be whether or not to use RVD. The short answer though is that unfortunately there is no good way to look back and determine what your cytogenetics are.

[goldmine848]

Re: What are the odds that I am high risk?

by goldmine848 on Wed Mar 12, 2014 1:24 pm

Thank you for the response. And you hit the nail on the head: do I use RVD for maintenance or just Revlimid. I prefer just Revlimid because of quality of life issues. Not an easy choice.

[Dr. Edward Libby]

Re: What are the odds that I am high risk?

by Dr. Edward Libby on Thu Mar 13, 2014 12:43 am

The odds are with you ... a 4 out of 5 chance that you are standard risk. If you feel strongly about quality of life and the simplicity of monotherapy with Revlimid then maybe the decision is not so hard. Best of luck in your journey with this challenging disease.