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Low dose Myeloma Induction
What do I mean by “low dose myeloma induction?“ I am a long-term MM survivor. Let me take a step back and tell you about my induction therapy in 1995.
At the time, the standard-of-care was Vincristine, Adriamycin and Dexamethasone aka VAD. The dose of dex at the time was 40mg. Much higher dose than what most people take these days.
Most importantly, VAD caused serious side effects yet only 50% of all newly diagnosed MM patients “responded.” When RVD was the FDA approved standard-of-care, it was shown that more than 90% of NDMM patients “responded.”
Daratumumab/Darzelex has recently been added to RVD induction therapy. Yes, a greater percentage of NDMM patients reach MRD but a greater number of NDMM patients develop side effects. In addition, we are seeing that MM patients undergo round after round of chemo, inevitably weakening their immune systems.
NOTE: almost half of all MM patients die not from MM but from infection.
My point is that I believe it is just as important to manage toxicity and your immune system as it is to kill your MM. For my money, RVD does a great job as a chemo cocktail for induction therapy.
- RVD Classic
- RVD Lite
- RVD Premium Lite
- RVD Ultra Lite
All provide good response but also provide different amounts of toxicity. Consider low dose myeloma induction.
Email me at David.PeopleBeatingCancer@gmail.com with questions about induction therapy.
Thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Clinical Outcomes of Non-Traditional Lenalidomide, Bortezomib, and Dexamethasone Regimens in Multiple Myeloma
Introduction- Lenalidomide, bortezomib, and dexamethasone (RVD) is a standard first-line regimen for patients with newly diagnosed multiple myeloma and is associated with high response rates and improvement in progression-free survival and overall survival compared to traditional chemotherapy regimens.
Traditional (RVD Classic, RVD Lite) and non-traditional (RVD Premium Lite, RVD Ultra Lite) variations of the RVD regimen are utilized at Dana-Farber Cancer Institute (DFCI) and have not been fully evaluated in terms of safety and tolerability.
RVD Premium Lite is administered in a 28-day cycle with weekly bortezomib; whereas, RVD Ultra Lite administers three weekly doses of bortezomib instead of four (Table 1). These two regimens have not been fully evaluated in terms of safety, tolerability, and efficacy.
Selection is based on provider preference in addition to flexibility of dosing schedule. The regimens also allow for convenience of weekly dosing while keeping dose intensity. This retrospective, descriptive analysis is the first study to explore the safety, tolerability, and efficacy of four different RVD regimens used at DFCI.
In conclusion, the current investigation allowed us to assess the safety, tolerability, and efficacy of traditional and non-traditional variations of the RVD regimen in multiple myeloma used at our institution. There are minimal differences between each regimen when toxicities are managed appropriately….”