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Myeloma Induction Chemotherapy- VGPR- What Next?
“It would be logical to think that a complete response (CR) or Very Good Partial Remission (VGPR) status translated into a longer overall survival…”
Dear Cancer Coach- My Mom had been diagnosed with Multiple Myeloma last October and undergone, 11 radiations and Induction Chemotherapy with VCD regimen. After 16 chemos, mom’s myeloma induction chemotherapy, she achieved VGPR.
Please note, Its not a M-band disease. and at diagnosis she had High grade plasmacytoma on right illiac bone and few minimum to low grade tumors at different places of the body. Basis biopsy, aspiration and B2 microglobulin this was finally diagnosed with MM stage 3.
Dr has given two options for treatment as next step:
- ASCT (High dose chemo is a part of it)
- Continue the same induction therapyNow i am in a dilemma which one to go with? Dr is preferring option 1 giving a guaranteed 1 year absolute extra benifit.After reading a lot somehow i feel I should not go with stem cell transplant right now rather keep it as an option in case relapse.Her age is now around 53years. Please help me to take this decision. Thanks & Regards, Andrew
Dear Andrew-
I am sorry to learn of your mom’s MM diagnosis. i will reply to your questions as best I can and then ask you a couple of questions in order to clarify some issues.
At 53, your mom is young as MMers go. This will increase her prognosis.
1) To confirm “Chemotherapy with VCD regimen.” Velcade, Cytoxan, Dexamethason. When you say “16 chemos” you mean 16 rounds or courses of this chemotherapy triplet cocktail? I am asking mainly because 16 rounds of this cocktail is a lot of toxicity for your mom to endure.
2) ” After 16 chemos she achieved VGPR” The blog post linked below includes a study/editorial by a MM specialist who talks about balancing toxicity with response from induction therapy. My point is that your mom, according to Dr. Rajkumar’s comments, will not necessarily increase her overall survival (OS) if she undergoes more chemo and more toxicity. Yes, achieveing either CR or VGPR is a positive indicator for longer overall survival but one is not better than another according to Dr. Rajkumar. And more chemo and toxicity may increase her adverse events aka side effects.
3) “and at diagnosis she had High grade plasmacytoma on right illiac bone and few minimum to low grade tumors at different places of the body” If you are saying that at diagnosis your mom had only bone involvement and no/few traditional diagnostic MM markers then her MM sounds identical to my own at diagnosis. We should discuss this further.
4) “After reading a lot somehow i feel I should not go with stem cell transplant right now rather keep it as an option in case relapse.” I agree with you.
My reasoning for agreeing with you Andrew, is that, as Dr. Rajkumar’s comments indicate, you and your mom can wait to have an ASCT without sacrificing any OS. Further, I’m not sure that more chemo of any kind, VCD or high dose chemo with ASC, will help and may very well hurt your mom. When I say hurt your mom, I mean that more toxicity may make any side effects worse. Taking a chemo vacation from toxicity may help her heal and gain strength if and when she undergoes more chemotherapy.
If you are interested I will email several of the MM cancer coaching guides to you for free of course. You and your mom may want to learn about both conventional and non-conventional MM issues and therapies.
Let me know.
Questions:
1) Is your mom experiencing any bone pain or chemotherapy-induced peripheral neuropathy (CIPN- burning or tingling)?
2) ” Its not a M-band disease.” I’m not sure what you are saying here. Are you saying that your mom is “non-secretory?” Meaning her blood testing does not show or indicate much of any MM disease?
Let me know what I am saying above makes sense. Hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Recommended Reading:
- Myeloma Cancer Coaching- Light Chains Increase Post ASCT-
- Living with Multiple Myeloma since 1994-My Cancer Story-
- Hemorrhagic Cystitis aka Irritable, Urgent, Frequent, Painful Bladder-
CR or VGPR Makes NO Difference in Newly Diagnosed Multiple Myeloma
“It would be logical to think that a complete response (CR) or Very Good Partial Remission (VGPR) status translated into a longer overall survival. I know I thought this when I had my autologous stem cell transplant. According to the two studies linked and excerpted below, I was wrong to think this.