My sister was diagnosed with multiple myeloma IdG they said its in 99% of her bones. She starts chemo (velcade) monday. what can she expect and what about the other meds. she needs.dexamethasone and Thalidomide and are very expensive she has no insurance any suggestions is greatly appreciated. She should apply for emergency Medicaid to help with the costs.
This is from Mayo Clinic literature:
Standard treatments for myeloma
Though there's no cure for multiple myeloma, with good treatment results you can usually return to near-normal activity. The appropriate multiple myeloma treatment depends on your needs, medical status and general health. You may also wish to consider approved clinical trials as an option.
Standard treatment options include:
Chemotherapy. Chemotherapy involves using medicines 鈥?taken orally as a pill or given through an intravenous (IV) injection 鈥?to kill myeloma cells. Chemotherapy is often given in cycles over a period of months, followed by a rest period. Often chemotherapy is discontinued during what is called a plateau phase or remission, during which your M protein level remains stable. You may need chemotherapy again if your M protein level begins to rise. Common chemotherapy drugs used to treat myeloma are melphalan (Alkeran), cyclophosphamide (Cytoxan), vincristine (Oncovin), doxorubicin (Adriamycin) and liposomal doxorubicin (Doxil).
Corticosteroids. Corticosteroids such as prednisone and dexamethasone (Decadron) have been used for decades to treat multiple myeloma. They are typically given as pills. Some research suggests that high doses of steroids may not be needed, and that lower doses may be safer and more effective.
Stem cell transplantation. This treatment involves using high-dose chemotherapy 鈥?usually high doses of melphalan 鈥?along with transfusion of previously collected immature blood cells (stem cells) to replace diseased or damaged marrow. The stem cells can come from you or from a donor, and they may be from either blood or bone marrow.
Thalidomide (Thalomid). Thalidomide, a drug originally used as a sedative and to treat morning sickness in the 1950s, was removed from the market after it was found to cause severe birth defects. However, the drug received approval from the Food and Drug Administration (FDA) again in 1998, first as a treatment for skin lesions caused by leprosy. Thalidomide is currently FDA-approved in conjunction with the corticosteroid called dexamethasone for the treatment of newly diagnosed cases of multiple myeloma. This drug is given orally.
Bortezomib (Velcade). Velcade was the first approved drug in a new class of medications called proteasome inhibitors. It is administered intravenously. It works by blocking the action of proteasomes, which causes cancer cells to die. One study showed that bortezomib had more than twice the response rate of a commonly used drug, dexamethasone. Bortezomib is approved by the FDA for use in a treatment for people with multiple myeloma who have received at least one prior therapy.
Lenalidomide (Revlimid). Lenalidomide is chemically similar to thalidomide, but appears to be more potent and cause fewer side effects. It is given orally. Lenalidomide is FDA-approved for use in combination with dexamethasone as a treatment for people who have received at least one prior therapy for multiple myeloma.
Radiation therapy. This treatment uses high-energy penetrating waves to damage myeloma cells and stop their growth. Radiation therapy may be used to target myeloma cells in a specific area 鈥?for instance, to more quickly shrink a tumor that's causing pain or destroying a bone.
Initial therapy for myeloma
The initial chemotherapy used to treat multiple myeloma depends on whether you're considered a candidate for stem cell transplantation. Factors such as the risk of your disease progressing, your age and your general health play a part in determining whether stem cell transplantation may be right for you.
If you're considered a candidate for stem cell transplantation: Your initial therapy will likely exclude melphalan because this drug can have a toxic effect on stem cells, making it impossible to collect enough of them. You may begin treatment with the most common initial myeloma therapy in the United States, thalidomide plus dexamethasone. Or your doctor may instead recommend a newer regimen, lenalidomide plus low-dose dexamethasone.
Your stem cells will likely be collected after you've undergone three to four months of treatment with these initial agents. Your doctor may recommend undergoing the stem cell transplant soon after your cells are collected or delaying the transplant until after a relapse, if it occurs. Your age and your personal preference are important factors that will help your doctor make his or her recommendation.
If you're not considered a candidate for stem cell transplantation: Your initial therapy is likely to be a combination of melphalan, prednisone and thalidomide (MPT). If the side effects are intolerable, melphalan plus prednisone is another option (MP). This type of therapy is typically given for about 12 to 18 months.
Treatments for relapsed or treatment-resistant multiple myeloma
Most people who are treated for multiple myeloma eventually experience a relapse of the disease. And in some cases, none of the currently available, first-line therapies slow the cancer cells from multiplying. If you experience a relapse of multiple myeloma, your doctor may recommend repeating another course of the treatment that initially helped you. Another option is trying one or more of the other treatments typically used as first-line therapy, either alone or in combination.
Research on a number of promising new treatment options is ongoing, and these drugs offer important options for those with multiple myeloma. Talk to your doctor about what clinical trials may be available to you.
Treating complications
Because multiple myeloma can cause a number of complications, you may also need treatment for those specific conditions. For example:
Back pain. Taking pain medication or wearing a back brace can help relieve the back pain you might experience with multiple myeloma.
Kidney complications. People with severe kidney damage may need dialysis.
Infections. Antibiotics may be necessary to help treat infections or to help reduce your risk of them.
Bone loss. You may take medications called bisphosphonates, such as pamidronate (Aredia) or zoledronic acid (Zometa), which bind to the surface of your bones and help prevent bone loss. Treatment with these drugs is associated with the risk of harm to the jawbone. If you're taking these medications, don't have dental procedures done without consulting your doctor first.
Anemia. If you have persistent anemia, your doctor may prescribe erythropoietin injections. Erythropoietin is a naturally occurring hormone made in the kidneys that stimulates the production of red blood cells. Research suggests that the use of erythropoietin may increase the risk of blood clots in some people with myeloma. I know Thalidomide has a patient assistance program to help with the cost. Her doctor can give her all the information. But you can check out this website also. Thalomid.com. I don't think dex is that expensive. |
