The Latest Myeloma News from the American Society of Hematology Meeting

Andrew Schorr:

Let's take another call. This one is from Henry. Henry, you're in the south up the road from Dr. Lonial in Georgia. You're in South Carolina?

Caller:

That's correct.

Andrew Schorr:

Where are you, sir?

Caller:

I'm in Charleston.

Andrew Schorr:

I love Charleston. Spoleto Festival, right?

Caller:

Yes, we love it too.

Andrew Schorr:

Okay, what's your question, Henry?

Caller:

Okay, Wednesday of this week, December 12th, I was diagnosed with multiple myeloma. I'm 62 years old. The information in mind, I'm stating it from a layman's perspective of course, but he said I had 15-20% of the issue, and you would know and understand what that meant, and my blood cells were described as being larger-than-normal red blood cells and some of them sticking together, and that's of course what moved to the diagnosis and then with the bone marrow exam.

My question is, my hematologist oncologist is recommending that is use the Revlimid with the dexamethasone by mouth or I can take it intravenously coming to his office. Of course, there is a considerable difference in the price, but that's not the big question. My question is, what do I do?

Andrew Schorr:

Okay, now let me make a couple of comments. We're going to go to another southerner there first, Dr. Lonial, because he's closest to you, but what I would comment is first of all for all of our questioners, obviously it's impossible for us, not me but our doctors, to practice medicine over the internet, so obviously you're going to have a discussion with your doctor, and I would recommend, I'm just going to tell you were I'm coming from, is I think it's great to get a second opinion in a fast moving field that we've been describing today with new very powerful data. For instance, would it be that combination, would it be the results of this trial with Velcade and the VMP trial, does that have any impact on you? What does it mean?

Dr. Lonial, so for someone just diagnosed a couple of days ago and with this sort of late-breaking news, how would you recommend Henry look before he leaps, if you will?

Dr. Lonial:

I think it's a real challenge, and even as you hear from the three of us on the call, there are often differences of opinion, and I think it doesn't necessarily mean that one of us is right and the other two are wrong. I think it just means that there are lots of different ways to approach this. So, I think that there are a number of factors that go into this. The first question that I think of when I hear at least part of your story is, do you even need treatment right now? Is there something in there that says this is symptomatic myeloma as opposed to having picked up an M protein very early on in the disease course, in which case we would want to just observe it for a period of time to see how it does, and there are a lot of factors that go into making that decision. It's a clinical decision. It's one that you make with the patient in front of you and not necessarily one, as Andrew mentioned, that you can make over the phone or over the internet. I think that our approaches in terms of how to decide which regimen is best for a given patient depends on how far the patient has to travel, what kind of risk factors they have, with what level of aggressiveness their disease presented, age, comorbid illness, and all sorts of other things go into that decision about whether you're going to use Revlimid, as your doctor is suggesting, or Velcade, which is also what your doctor suggested, or whether it would be VTD, Velcade with thalidomide and dexamethasone, or RVD, Velcade with Revlimid and dexamethasone. There are a lot of different issues that I think go into it, and I agree with Andrew also in the sense that I think it makes a lot of sense to potentially get a second opinion because there's not any downside; I mean, when I see patients for the first time, if they want to go for a second opinion, I encourage them to do that as well because I think you want to make sure you hear information from as many different people as you can before you embark down the road of treatment.

Andrew Schorr:

Hopefully that helps you Henry. Good luck to you. I'll just tell you, now my disease has been different, so I don't want to make too many parallels, but chronic lymphocytic leukemia, I had never heard of it when I got it, and in that particular case it was sort of smoldering for a while like Carol was saying earlier, and so I actually didn't have treatment for a very extended time, and when I did, by the way, I was in a phase-II trial, so have part of your discussion be based on the results of these trials, is there something that you would offer me that makes sense, and second of all is there anything in research that may be should be discussed as a possible treatment option too. Like you heard, there is earlier data now with Revlimid and Velcade used together. Does that make sense? Maybe Dr. Berenson would say no yet while toxicities etc that's being investigated, but the point is that's part of the discussion too. That's just the counsel I would give you as somebody who has been down the road of treatments with something I had never heard of before.

Andrew Schorr:

I want to get to some e-mail questions, and we'll fire them off to our west coast doctors too. This is from Barbara from Richmond, Virginia. She says, 'Would you recommend a delay of a stem cell transplant if I'm asymptomatic and my M protein level is 5%? I'm currently taking dex and Revlimid, and I was diagnosed in September.'

Let's go with Dr. Durie, since you're involved in transplants some. What about whether she delays or not? Any thought on that just generally?

Dr. Durie:

Sure. I think that it's very reasonable, and I think that this is obviously a common question. If you're in remission, and you're doing well, it's hard to look at doing a significant procedure like an autologous stem cell transplant, and so the compromise position, which I think is particularly helpful on the Revlimid low-dose dex, is to harvest the stem cells and to save them so that you do have them available for the future, and that is actually what were doing in an upcoming Southwest Oncology Group trial where after four cycles of Revlimid and dex, we are harvesting the stem cells and then having patients continue with Revlimid and dexamethasone. As we touched on earlier, I think a particularly important part about the Revlimid and dex is that you certainly can stay on it, and the level of benefit does improved and increase over time, and so there's definitely and opportunity to stay on that, and then if you have your stem cells, those can be available for a transplant later on, so that would be the way that I would look at it.

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Page last updated on November 22, 2013