It sounds counterintuitive that an t11/14 seems to be a good thing for relapsed/refractory multiple myeloma survivors. But maybe…
When you were diagnosed with multiple myeloma, FISH analysis determined that you had a genetic abnormality- a t11/14 or 11/14 translocation. You thought this meant that your MM was more difficult to treat. So when you became relapsed/refractory you weren’t surprised.
Don’t misunderstand me. Relapsed/refractory multiple myeloma is not only difficult to treat but can mean that you are running out of options to manage your MM.
After years of treatment, toxicity, side effects, etc. you may be getting tired. Your MM is wearing you out.
According to the study linked and excerpted below, your t11/14 increases the likelihood of your relapsed/refractory MM responding to the triplet chemo cocktail ventoclax, bortezomib (velcade) and dexamethasone (VVd).
Before you jump for joy or rush to schedule an appointment with your oncologist, keep in mind that the study below does not discuss the side effects aka adverse events experienced by the trial group. Yes, the group of MM patients responded well to VVd but a what cost?
Also keep in mind that if you have already undergone 1-3 different types of chemotherapy, your body will probably be exhausted from all the previous toxicity. Consider complementary therapies to boost your immune function such as moderate exercise, yoga, whole-body hyperthermia, massage, others.
I have linked websites listing the side effects aka adverse events of both ventaclax as well as velcade below. It is possible that the combination of these two toxic therapies could worsen common side effects. Further, if your body is already wracked with previous chemotherapy, you may be more susceptible to yet another chemotherapy triplet.
My apologies for being a bit of a Debby Downer. I believe an ounce of prevention is worth a pound of cure.
Have you become relapsed/refractory? Are you t11/14? Scroll down the page, post a question or comment and I will reply to you ASAP.
Hang in there,
- MM Survivor
- MM Coach
- Director PeopleBeatingCancer
“The phase III BELLINI trial (NCT02755597) demonstrated translocation(t)(11;14) and high BCL2 gene expression are predictive of response to treatment with the addition of venetoclax (Venclexta) to bortezomib (Velcade) plus dexamethasone in patients with relapsed/refractory multiple myeloma…
Moreover, the triplet regimen led to promising response rates in patients with relapsed/refractory myeloma…
In the venetoclax arm,
- 61% of patients achieved a very good partial response (VGPR) or better,
- 29% achieved a complete response (CR) or better, and
- 13% of patients achieved minimal residual disease (MRD)-negativity
versus 40%, 7%, and 1% in the placebo arm, respectively…
In the t(11;14) subgroup, venetoclax induced a
- 95% ORR,
- including a ≥VGPR of 75% of patients,
- a ≥CR of 55%, and
- MRD-negativity in 25%
versus 47%, 27%, 7%, and 0% with placebo, respectively…
The randomized double-blind, multicenter phase III BELLINI trial evaluated the efficacy of adding venetoclax to bortezomib plus dexamethasone compared with placebo and bortezomib plus dexamethasone in patients who received 1 to 3 prior lines of therapy and were either sensitive or naïve to proteasome inhibitors (PIs)…
Patients also had to have received 1 to 3 prior lines of therapy, which could include prior bortezomib or another PI. However, patents were not included if they became refractory to a prior PI, received a PI treatment within 60 days of the first dose of the study drug…
Venetoclax is a highly selective and potent oral BCL-2 inhibitor, which can induce apoptosis and has synergistic activity with bortezomib plus dexamethasone. Previous phase I data demonstrated encouraging clinical efficacy with the triplet regimen in patients with t(11;14) multiple myeloma, as well as in a broader population of patients with myeloma…”
“In Summary- Commonly reported side effects of venetoclax include: tumor lysis syndrome and neutropenia. See below for a comprehensive list of adverse effects…”
“Along with its needed effects, bortezomib may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur while taking bortezomib…”
Relapsed/Refractory Multiple Myeloma- VDT PACE
For heavily pre-treated patients with relapsed/refractory multiple myeloma (RRMM), bortezomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide and etoposide (VDT PACE) regimen and its modifications (VDT PACE-like regimens [VPLRs]) are effective”
Your cancer, multiple myeloma, is both incurable and treatable. The articles below are evidence of this contradictory statement. If you are similar to the study participants below, you have already undergone at least four therapies and an autologous stem cell transplant. You probably have been in and out of remission several times. You have relapsed/refractory MM yet you may consider VDT PACE…
The point of this post is to clearly outline what the article means when it says VDT-PACE is effective.
First and foremost you will be exposing your body to a lot of toxicity. As a long-term MM and MM Coach I encourage you to consider complementary, integrative therapies that research shows can minimize the toxicity of chemotherapy. My guess is that you are willing to undergo this toxicity because you are running out of therapy options.
The good news is that the top 10% of MMers who undergo VDT-PACE will achieve a very good partial remission. A little more than half of the patients (54.4%), experienced a partial remission. And then about two-thirds of patients experienced a minimal response.
While myeloma is considered to be very treatable, MMer will experience short, long-term and late stage side effects along the way and these MMers will eventuall be told that nothing more can be done for them. Please consider those evidence-based but non-toxic, non-conventional therapies that research has been shown is cytotoxic to MM and can reduce chemotherapy’s side effects.
My name is David Emerson. I have lived with MM since 1994 and have researched and produced a MM cancer coaching program based on MM research as well as my experiences as a long-term MM survivor.
“For heavily pre-treated patients with relapsed/refractory multiple myeloma (RRMM), bortezomib, dexamethasone, thalidomide, cisplatin, doxorubicin, cyclophosphamide and etoposide (VDT PACE) regimen and its modifications (VDT PACE-like regimens [VPLRs]) are effective, according to a study published online Oct. 25 in the American Journal of Hematology…
Patients had received a median of four prior therapies, including stem cell transplant (SCT) in 66.7 percent. Overall. 67.4 percent of patients received VDT PACE, 14.2 percent received VD PACE, and 18.4 percent received other VPLRs. A median of one cycle of VPLR was received by patients…
The researchers observed
- ≥ %68.4 minimal response,
- ≥ %54.4 partial response (PR), and
- ≥ %10.3 very good PR, patients, respectively.
Median progression-free and overall survival was 3.1 and 8.1 months, respectively.
Overall, 82.3 percent of patients received some therapy after VPLR:
- 61.2 percent received systemic chemotherapy and
- 38.8 percent underwent SCT.
For those who received SCT after VPLR, median overall survival was 15.1 months. For patients receiving VPLRs, age ≥60 years and revised international staging system III stage predicted shorter overall survival (hazard ratios, 2.3 and 2.4, respectively).”
“Experience with intensive chemotherapy for relapsed/refractory multiple myeloma (RRMM) using VDT PACE regimen and its modifications (VDT PACE-like regimens: VPLRs) outside TOTAL THERAPY trials is limited.
We analyzed the outcomes of 141 patients with RRMM who received VPLRs at our center between 2006 and 2017 in an intent-to-treat analysis.
Median age was 59.7 years and 66.7% of patients were male. A median of 2.2 years (range 0.02-11.4) separated diagnosis of myeloma and inititation of VPLR.
High-risk cytogenetics were present in 52.4% patients. Patients received a median of 4 (range 1-14) prior therapies, including stem cell transplant (SCT) in 66.7% patients.
- ≥ minimal response in 68.4%,
- ≥ partial response (PR) in 54.4% and
- ≥ very good PR in 10.3% patients.
Median progression-free survival was 3.1 months (95% CI, 1.9-3.9) and median overall survival (OS) was 8.1 months (CI, 6.2-9.9). One-hundred and sixteen (82.3%) patients received some therapy after VPLR; 71 (61.2%) received systemic chemotherapy, while 45 (38.8%) underwent SCT. Median OS for those who received SCT after VPLR was 15.1 months (CI, 10.3-20.8).
Age ≥ 60 years (hazard ratio [HR] 2.3 [CI, 1.4-3.7]; P = 0.0008) and R-ISS III stage (HR- 2.4 [CI, 1.3-4.0]; P = 0.003) predicted shorter OS in patients receiving VPLR.
VPLRs are effective in heavily pre-treated RRMM. In fit patients, SCT can be used to consolidate the response to VPLR.”