Multiple Myeloma Treatment: Questions About Therapy Options

Multiple Myeloma

Dear Director,
My father is seventy years old and was diagnosed with multiple myeloma last June.
An X-ray report indicated that his bones were not affected.
He began treatment with Velcade in late June last year, completing eight cycles by early March.
His IgG levels decreased from 3480 before treatment to 1590 currently.
During a recent consultation, his attending physician informed him that he would receive Rituximab treatment in two weeks.
I would like to ask you two questions:
1.
Does the quick transition to another medication indicate that the previous Velcade treatment was not effective, or is it common practice for physicians to provide continuous maintenance therapy?
2.
The health insurance covers twelve cycles of Rituximab.
If Rituximab is administered soon after completing the Velcade treatment, will this lead to a situation where there are no available medications if there is a relapse in the future?
3.
As you know, older individuals sometimes hesitate to ask too many questions during medical visits for fear of upsetting or bothering the physician.
They often keep their concerns to themselves.
As his daughter, I want to help clarify these issues for him.
I would greatly appreciate your assistance in this matter.
Thank you.

Miss Chen, 40~49 year old female. Ask Date: 2016/05/01

Dr. Lai Yicheng reply Oncology

Dear Ms.
Chen,
Thank you for your letter.
Here are my responses:
1.
Regarding your IgG level of 3480, the unit is either g/L or mg/L.
If the unit is g/L, the current level of 1590 g/L is still too high, indicating that the treatment effect is not ideal, which is why the physician has switched to Revlimid.
2.
In the event that Revlimid is ineffective, there are other medications available for use.
Please discuss this further with your attending physician.
Changhua Hospital cares about you.
Sincerely,
Dr.
Lai Yi-Cheng
Department of Radiation Oncology

Reply Date: 2016/05/01

More Info

Dear Patient,
Thank you for your inquiry regarding the treatment options for multiple myeloma, particularly concerning your father's recent treatment journey. I understand that navigating the complexities of cancer treatment can be overwhelming, especially when it involves the well-being of a loved one. Let’s address your questions one by one.

1. Transitioning to a New Treatment: The decision to switch from one treatment to another, such as from Velcade (bortezomib) to Revlimid (lenalidomide), can be influenced by several factors. It does not necessarily indicate that the previous treatment was ineffective. In many cases, oncologists will initiate a new therapy as part of a maintenance strategy to continue controlling the disease. The goal is to keep the myeloma in check and prevent it from progressing. The reduction in your father's IgG levels from 3480 to 1590 is a positive sign, indicating that the Velcade treatment was effective in reducing the myeloma burden. However, oncologists often recommend transitioning to a different agent to further enhance treatment efficacy and manage potential resistance that can develop with prolonged use of a single agent.

2. Concerns About Future Treatment Options: Your concern about running out of treatment options is valid, especially in the context of multiple myeloma, which can be a relapsing disease. However, the treatment landscape for multiple myeloma has expanded significantly over the years, with numerous therapies available, including immunomodulatory drugs, proteasome inhibitors, monoclonal antibodies, and CAR T-cell therapies. The use of Revlimid as a subsequent treatment is a common practice and is generally well-tolerated. It is important to remember that the healthcare team will monitor your father's response closely and adjust the treatment plan as necessary. If he were to experience a relapse in the future, there are still several other treatment options available, including newer therapies that may not have been utilized yet.

3. Encouraging Open Communication: It’s commendable that you are advocating for your father’s health and encouraging him to ask questions. Open communication with healthcare providers is crucial in managing cancer treatment. Patients and their families should feel empowered to discuss their concerns, treatment options, and any side effects they may be experiencing. It is essential for the medical team to understand the patient's perspective and preferences, as this can significantly influence treatment decisions and overall satisfaction with care.

In conclusion, while the transition to Revlimid may raise concerns about the effectiveness of previous treatments, it is a standard practice aimed at maintaining disease control. The landscape of multiple myeloma treatment is diverse, and there are numerous options available should your father need them in the future. Encourage him to engage with his healthcare team openly, as this will foster a collaborative approach to his treatment.

If you have any further questions or need additional clarification, please do not hesitate to reach out. Wishing your father the best in his treatment journey.

Warm regards,
Doctor Q&A Teams
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