Mario has now completed 4 cycles of drug therapy (Revlimid/DEX) and the protein level plateau reached is 1,700 from an initial reading of 6,000. Dr. Carol Ann Huff of Johns Hopkins and Dr. Ashraf of the University of Maryland Medical Center presented 2 different treatments options. Dr. Huff was of the opinion that a transplant would not result in significantly improved results as compared with just continuing drug therapy. She suggested incorporating Velcade at a stage where Revlimid ceases to be effective. Dr. Bodras regognizes the limited benefits of a transplant but proposes a much more aggressive approach, with a Velcade/Citoxan/DEX “cocktail” followed by an autologous transplant. The risk factors associated with the transplant are not well defined or supported but appear to be in the 5% morbidity range. The end point appears to be the same, the only difference being how it is reached and what risks are associated with the process. We have chosen to proceed to stem cell collection but not necessarily follow it by a transplant.
Mario is now beginning his 5th cycle of Revlimid/DEX therapy. The combination will continue to a 6th cycle when another decision has to be made (depending on how the meds are working). This will be determined by the rise or fall of the IGA protein level. Preparations will be initiated for a stem cell collection. The stem cells will be frozen for possible use at a later time. The decision as to where the procedure will be performed must be determined, whether it will be Johns Hopkins or the University of Maryland Medical Center. Decisions, decisions…..