Category: Myeloma Treatment

Myeloma Treatment

Velcade & Doxil Update

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I’ve been on Velcade & Doxil since January now, so it’s time for another update. There have been a few cycles during which I missed a dose because of a rash, shingles and a trip to Mayo.

I’ve tolerated Velcade & Doxil quite well, with the exception of the skin problems. I also have a problem with the skin on my hands, which we think comes from the Doxil (HFS). Last Friday when I had treatment, I tried a suggestion from on of my doctors. During the infusion, I held an ice pack in each hand. They call this regional cooling, and more information can be found here:

http://doxil.com/optimize_treatment/managing_side_effect.jsp

What happens to me is that the skin on my hands splits open and the result is soreness and ever-present bandaids.

During my treatment, I receive some IV dex and benadryl to help lessen the hives (rash) that appeared after my second cycle. Since I started having the premeds, the hives have been practically non-existent.

I also have Anzemet, an anti-nausea drug. I’m not really sure that I need it, but I don’t want to find out. I think the Anzemet may be responsible for a headache I get the night of treatment. When there are so many things being pumped into your vein, there’s no way to be sure.

So far, the drug combo has worked for me. My IgA and m-spikes are still not in the normal range, but my bone marrow biopsy indicates that the % of plasma cells is down to 6.2%, and it was 30% last fall after Rev/dex (20% BEFORE Rev/dex).

I plan on staying with this regimen while I think about SCT and other things, and hope that it continues to work (even slowly) while I ponder.

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Velcade and Doxil Side Effects

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Here’s some advice I got about Velcade/Doxil from one of the researchers involved in early trials. I thought I’d pass it on.

Myeloma treatment with DoxilWith the Velcade and Doxil, have they started you on oral Vit B6? When we used to run the Phase I study of that combination, we have recommended pyridoxine (Vit B6) 200 mg by mouth daily. I think this is even over the counter but you can definitely let your local doctor be aware that you are taking this. This drug is to prevent the hand-foot syndrome which is a potential side-effect of the Doxil.

There is also the risk of neuropathy with Velcade. A patient once told me that the Velcade neuropathy (which is more of pain) is different than the Thalidomide/Revlimid neuropathy (which is more of the numbness and tingling sensation). As of this time, there is no approved treatment for neuropathy or formal studies comparing all the drugs that are being used to alleviate neuropathy. We have been using either Neurontin or Lidocaine patch.

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STC soon, most likely

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I saw the doctor yesterday. The chemo I had in October did nothing for me, so I need to have some more and then on to a transplant. They don’t really do many bone marrow transplants anymore. Instead, they use stem cells. It will probably be February by the time I’m admitted for my transplant. In the mean time, I’m going to try to enjoy myself as much as possible, exercise a lot more (so I can be stronger for the transplant) and do some kind of chemo, which has yet to be determined. I failed a few treatments, so there’s one choice left, pretty much (Velcade in some combo). I’m in a situation where my cancer grows whenever I’m not constantly being treated for it. Time off is great and feels wonderful, but my disease likes it too. I’m not going to lie. I worry about my dog outliving me, and what will happen to him. How can I be sure he’ll be taken care of and loved? My cat, too.

I have an appointment on December 13 to see the transplant doctor.

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Bone Marrow Biopsy

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I had a bone marrow biopsy yesterday. I got one of these, and decided to take a picture of it so you could see what the needle looks like. This time I had an IV of 2 mg ativan. I can’t say that it helps much, but it sure doesn’t hurt. I don’t know what all these parts are for, but here they are!

Goldenberg Snare Coil (Bone Marrow Biopsy Needle)

Manufacturer’s Home Page. This used to include some video demonstrations of the Goldenberg Snarecoil in use.  Now it’s branded Monoject.

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Did you know this about melatonin?

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If you’re on steroids, you should avoid melatonin.

Precautions: There are no known serious side effects to regulated melatonin supplementation. Some people may experience vivid dreams or nightmares. Overuse or incorrect use of melatonin could disrupt circadian rhythms. Long-term effects have not been well studied. In rats, melatonin decreases T4 and T3 uptake levels.

Melatonin can cause drowsiness if taken during the day. If morning drowsiness is experienced after taking melatonin at night, reduce dosage levels. In some cases of depression, daytime doses of melatonin can increase depression.

May be contraindicated for those with autoimmune disorders and immune system cancers (e.g., lymphoma, leukemia).

Because melatonin suppresses corticosteroid activity, those who are taking corticosteroids for anti-inflammatory or immune suppressive purposes (e.g., transplant patients) should exercise caution with melatonin supplementation.

Melatonin could interfere with fertility. It is also contraindicated during pregnancy and lactation.

Lack of sleep and insufficient exposure to darkness may suppress natural production of melatonin.
http://www.wellfx.com/InfoBase/vitamin_melatonin_.htm

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Side effects?

Last night I started to develop a few little itchy spots on my arms and hands and my right eyelid swelled a little. By morning, the spots on my arms and hands were gone, but my entire right eyelid was swollen and red. At this moment, both eyelids are swollen and red, and so are my fingers. There are some itchy raised spots on my arms and legs too, mostly around the joints.

I’ve been taking Thalomid and dexamethasone (in 4 pulses of 4 days on/4 days off – 40 mg each day) for about a month now. Why would side effects manifest themselves at this point? Maybe there’s some cumulative effect with dexamethasone. It’s possible, because up until the third pulse, I hadn’t experienced that meanness other people talked about. Boy, was I in a bad mood! I could relate to what the others were saying.

I called my oncologist’s office this afternoon when it appeared that the itchy swelling wasn’t going away, but getting worse. He wasn’t in, so I called my primary care physician. He thinks it’s a result of the high doses of steroids and said I could take Benedryl to help with the itching and swelling. I must need a lot, because what I’ve taken so far today hasn’t put a dent in it. It would be nice if I could go to my vet and get a shot. :) If it’s not better in the morning, I’ll call my oncologist again.

I’m not sure if I should go ahead and take my evening dose of Thalomid or not. Tomorrow morning I start my last pulse of dex. Dex is supposed to help swelling :)

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24hr Urine 24 Mar 2003

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Date of specimen: 3/24/2003

TEST RESULT LIMITS
Protein, Total, Urine 5.2 mg/dL 0.0 – 15.0
Protein, Urine 24 hr 150.8H mg/24 hr 30.0 – 150.0
Albumin, U 59.6 %
Alpha-1-Globulin, U 14.3 %
Alpha-2-Globulin, U 11.0 %
Beta Globulin, U 7.5 %
Gamma Globulin, U 7.6 %
M-Spike, % Not observed
Immunofixation result, urine
Bence Jones Protein positive lambda
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