[clay1980]

What next?!

by clay1980 on Wed Dec 11, 2013 10:44 am

My dad is 55 years old and was diagnosed with multiple myeloma in August, with a single lesion. The doctors wanted to start with chemo (Velcade), Zometa and "aggressive" radiation. He is done with the radiation and nearing the end of his chemo rotations. He went yesterday for a CT scan to see where we are and left learning that not only is the lesion syill there, but blood work indicates that the cancer is spreading? There was talk about a stem cell transplant before this but that was when they thought that the lesion would be resolved w/ the initial treatment.. whats next? Can they still do SCT?

[lys2012]

Re: What next?!

by lys2012 on Wed Dec 11, 2013 12:44 pm

Hi,

First off I just wnat to say try not to panic too much yet. Bone leasions take a long time to heal, they can become inactive, but then it takes a long time to heal the lesion, so you can still see it months later on scans. CT scans in my experience are the most detailed for bone lesions. In my case MRI noted only a few (vetrabrate collapse at one level) but then when I had a CT scan for a lung infection as a side note it noted multiple lesions throughout the thoracic, not just one vertabrate as per the MRI. And this was a month after my Stem cell transplant (aftert 6 months of treatment)!

Was your dad on any other drugs beside the Velcade? I believe that most "induction" (the initial chemo treatment) usually has two or three drugs because they act synergistically, and compliment each other. If he was only on Velcade then I think they next step would be to add another drug along with it (revilmide or dex?) and see if that helps?

[Multibilly]

Re: What next?!

by Multibilly on Wed Dec 11, 2013 1:19 pm

Hi Clay,

Sorry to hear about your Dad. I realize that this is a tough time for your family.

First off, we aren't doctors and are not experts, but there a few great docs that monitor this site and chime in every few days.

With that in mind:

1. Are you working with a multiple myeloma specialist or a general oncologist? You really want to be hooked up with a multiple myeloma specialist if you aren't already. This is the most important thing you and your Dad can be doing.

2. It sounds like he has what is known as solitary plasmactyoma. The usual course of treatment for a solitary plasmacytoma is just radiation. Note that lytic lesions don't "go away" with treatment (but there is some debate on this subject). Rather, their development is arrested with treatment. See this link for further info: https://myelomabeacon.org/news/2012/05/04/solitary-bone-plasmacytoma/

3. Do you know what stage of myeloma he has based on his bloodwork and bone marrow biopsy (I assumed he had a bone marrow biopsy)? I'm guessing that he is either at an MGUS or smoldering level, but has been diagnosed with a solitary plasmacytoma? You need to know the M-Spike and plasma cell % from the bone marrow biopsy to figure this out.

4. In general, one doesn't consider chemo or an SCT until one becomes symptomatic based on meeting one or more of the following CRAB criteria (hyperCalcemia, Renal (kidney) issues, Anemia, multiple Bone lesions). If he indeed has a solitary plasmacytoma, he must have a bone plasma % of greater than 30% in order to meet the "B" in CRAB. See the link: http://myeloma.org/ArticlePage.action?tabId=1&menuId=334&articleId=3462&aTab=-1

5. Don't rush into treatment. Do your homework first. Also be aware that an SCT isn't your only choice here. The latest chemo treatments are showing great results and there are several "cocktails" to choose from. Take the time to read the various debates on this site regarding whether to do an SCT or not.

Again, if you aren't working with a multiple myeloma specialist, seek one out. Good luck to you and your Dad.