Doctors Lounge - Oncology Answers
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Forum Name: Multiple Myeloma
Question: Options if chemo fails?
|ohioles - Fri Nov 04, 2005 7:54 pm||
My 69 yr. old mother was diagnosed with MM 2 months ago. She was considered Stage II at diagnosis with a Beta 2 Micro level of 3.6 and albumin 3.9. She has kappa light chain disease and has had arthritis for many years. She's had 2 cycles of doxil, vincristine and dexamethasone. After the first cycle the doctor told us that she may only have to do 3 cycles since her numbers looked so good. We were elated since she has been accepted for a autologous stem cell transplant in Atlanta (providing she is physically ready). Two days ago, the doctor told her that he didn't like her protein numbers (kappa had gone from 9.54 before treatment, to 5.0 after first chemo, to 6.0 after second treatment. Her total proteins are now 8.5, up from 8.0.
She doesn't seem to have any kidney problems, but does have degenerated L3 & L4 disks with back pain when she's off the dex. The dex also causes extreme difficulty with sleeping. She's taken 8 different sleep meds but has finally settled on Remeron 30mg with about 1 1/2-2mg of xanax per night and this gives her from 4-6 hours of sleep. I left my teaching job to help dad care for mom and we are now feeling very anxious about everything. Can you tell me what our options might be if this chemo treatment fails? Are there other combinations she could try? Do we then go to some of the newer drugs like Velcade or Revlimid or what?? I thought Emory said they would consider doing a transplant even if a person wasn't in remission...is this possible?? Originally the doctors gave us the impression that mom probably had 3-7 years to live with the new advances happening in this area but now we just feel confused and frankly, frightened. Any information you would be willing to share would be greatly appreciated!! Thanks
|Dr. Safaa Mahmoud - Sun Jul 16, 2006 11:29 am||
The 5-year survival rate for MM patients treated with conventional therapy is 20%-25% for those older than 65 years.
About 30%-50% of newly diagnosed multiple myeloma patients are expected to be unresponsive to chemotherapy.
The criteria for partial response are:
■ > 50% reduction in serum myeloma protein
■ > 90% reduction in Bence Jones protein.
Criteria for complete response include:
■ disappearance of serum myeloma protein and Bence Jones protein by
■ no monoclonal plasma cells in bone marrow.
In those who are resistant to VAD- combination chemotherapy Like in her case can be offered one of the following therapies:
- Combination chemotherapy.
High doses of alkylating agents, alone or in combination are proved to be effective in these patients.
Examples of these regimens are:
IV melphalan (70-100 mg/m2)
The combination of high-dose cyclophosphamide (Cytoxan,
Neosar) and etoposide.
- Thalidomide is of role in treatment of refractory/relapsed multiple myeloma, and shows 50% reduction in paraprotein in almost 30% of patients. Remissions obtained are durable.
- Novel agents have shown good activity in the disease control and studies on these drugs are still going on, these agents include:
IMiD Revimid thalidomide analog with immunomodulatory effects.
Proteasome inhibition Bortezomib
Arsenic trioxide (Trisenox)
I advise you to follow up with her doctor for proper management.
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