Myeloma Survival Benefit With Lower Dose Of Steroids

I thought this new information was very important ... 

Results of Eastern Cooperative Oncology Group Phase III clinical trial E4A03, for multiple myeloma, showing significantly better overall survival with lenalidomide (revlimid) plus low-dose dexamethasone therapy compared to lenalidomide plus high-dose dexamethasone.

Full article:

http://www.eurekalert.org/pub_releases/2007-12/mc-mmc120607.

Regards,

Craig Persel 

How many mg's (of say Decadron) per week or month would be considered high vs. low dose?

Good question. I had the same, but it was not included in the short article. I will try and track down more information and pass it along.

To use my own wife as an example ... when she started on Thal/Dex she was being given 40mg of Dex. Now she is on Velcade and receiving 20mg. I'm not sure if this constitutes high vs. low, but there definitely is a difference in side effects.

I'll see what details I can find about this study.

Regards,

Craig 

Got it ...

"Patients in the high-dex group received Dex 40 mg days 1-4, 9-12, and 17-20 PO every 28 days. Patients in the low-dex group received Dex 40 mg days 1, 8, 15, and 22 PO every 28 days."

So ... both groups received 40mg of Dex, but the high-dex group it 12 out of 28 days whereas the low-dex group received it only 4 out of 28 days. 

Very useful information, in my opinion, for future treatment of myeloma using Rev/Dex.

Regards,

Craig Persel 

Thanks.  This is helpful.  I have been on Revlimid for a little over 1 yr. along with 35 mg (for most of the time) of decadron per week.  I guess this puts me at a slightly lower dose than the "low dose."  Response has been great - steady improvement in test results and now in complete remission. For now, we are continuing the Revlimid, but gradually reducing/removing the steroids to see what happens.

I've been on Revlimid for 17 months now without dex. and have had excellent results for the entire time.  I started on 50mg, dropped to 25 in the second month and went down to 10mg from the third month.  So only 10mg of Revlimid has kept my paraprotein down from 90 to 7 and with the only side effect a bit of nausea.  Unfortunately over the last couple of months my level has risen to 11 -- not much but it probably means that it is not as effective as before.  I'm not sure what will happen next -- do we increase the dose or change to something else?  I see my doctor on Friday so we'll talk about it then.    I wonder just how much better could it have been with dex, and is dex really needed at all?  It seems to me that most people seem to have major problems/side effects as a result of the steroids -- not necessarily because of the thalid/velcade/revlimid.  Its more about finding the drug that works best for you -- regardless of the side effects or problems that other people may have had -- and stick with it for as long as it is giving you positive results!  Best wishes to you all, Cath