jm's Adventure with Multiple Myeloma: Lab Values, Dr. Visit, Velcade, and Review of Carfilzomid - October 23 2012

Total Pageviews

Click on photos to make them larger and clearer. New to the blog, the oldest or beginning entries are at the bottom and you read upwards to the most recent date or go to Labels and begin with Entry 1. Use the alpha Labels on right to find topics of most interest to you.

Tuesday, October 23, 2012

Lab Values, Dr. Visit, Velcade, and Review of Carfilzomid - October 23 2012

Up early in the dark for my trip to St. Luke's Hospital MSTI (Mountain States Tumor Institute) in Twin Falls, Idaho. Left early because it snowed yesterday and so I could go more slowly watching for critters (deer, moose, elk) in the road, but I didn't encounter any.

My blood draw went well and I was careful to hold the site for 5 minutes afterwards since I expected that my platelets were improving, but still below normal.

My white blood cells were almost normal at 4.4 (norms 4.5-11); hemoglobin normal at 12.3 (norms 12-15); and my platelets were up from 80 last week to a normal of 149 (norms 140-440). So, my bone marrow is recovering from the Zolinza (vorinostat) in these values.
My creatinine was lower at 1.16 (norms 0.52-1.04) from 1.47 last week on 10/16/2012 and 1.20 on 10/20/2012. My BUN remains normal at 11 (norms 7-170. So, it appears that my kidney function tests are on the mend. I will continue to drink lots of fluids daily (3,000 to 3,500 ml).

My LDH is soaring at 993 (norms 313-618) - goes well with the relapse.

After my labs were back, I saw Dr. Padavanija and nurse Kendi. They have been working on getting insurance approval for the Carfilzomib (Kyprolis) and Revlimid (lenalidomide). I gave them my insurance Case Manager's phone number and they had to leave a message. At any rate, the new medications are not yet available and I got Velcade/Dex instead. I called Curascript and completed my Celgene Survery for the Revlimid 10 mg. They will send it to me as soon as the insurance approves it.

I'm thinking this is not all negative, since it will give my bone marrow another week to recover from the Zolinza (vorinostat) that didn't help me - just depressed my bone marrow and abnormally increased my kidney function tests.

The Carfilzomib (Kyprolis) information is a tad scary. I can only hope the benefits for me outweigh the risks and that Zolinza (vorinostat didn't ruin my heart - I still have flip-flop feelings in my heart and racing heart rate at times).

WARNINGS AND PRECAUTION Carfilzomib (Kyprolis) 


The safety of KYPROLIS was evaluated in clinical studies of 526 patients with relapsed and/or refractory multiple myeloma.
Cardiac Arrest, Congestive Heart Failure, Myocardial Ischemia 
Death due to cardiac arrest has occurred within a day of KYPROLIS administration. New onset or worsening of pre-existingcongestive heart failure with decreased left ventricular function or myocardial ischemia have occurred following administration of KYPROLIS. Cardiac failure events (e.g., cardiac failure congestive, pulmonary edema, ejection fraction decreased) were reported in 7% of patients. Monitor for cardiac complications and manage promptly. Withhold KYPROLIS for Grade 3 or 4 cardiac events until recovery and consider whether to restart KYPROLIS based on a benefit/risk assessment. Patients with New York Heart Association Class III and IV heart failure, myocardial infarction in the preceding 6 months, and conduction abnormalities uncontrolled by medications may be at greater risk for cardiac complications.
Pulmonary Hypertension
Pulmonary arterial hypertension (PAH) was reported in 2% of patients treated with KYPROLIS and was Grade 3 or greater in less than 1% of patients. Evaluate with cardiac imaging and/or other tests as indicated. Withhold KYPROLIS for pulmonary hypertension until resolved or returned to baseline and consider whether to restart KYPROLIS based on a benefit/risk assessment.
Pulmonary Complications
Dyspnea was reported in 35% of patients enrolled in clinical trials. Grade 3 dyspnea occurred in 5%; no Grade 4 events, and 1 death (Grade 5) was reported. Monitor and manage dyspnea immediately; interrupt KYPROLIS until symptoms have resolved or returned to baseline.
Infusion Reactions
Infusion reactions were characterized by a spectrum of systemic symptoms including fever, chills, arthralgia, myalgia, facial flushing, facial edema, vomiting, weakness, shortness of breath, hypotension, syncope, chest tightness, or angina. These reactions can occur immediately following infusion or up to 24 hours after administration of KYPROLIS. Administer dexamethasone prior to KYPROLIS to reduce the incidence and severity of reactions. Inform patients of the risk and symptoms, and to contact physician if symptoms of an infusion reaction occur.
Tumor Lysis Syndrome
Tumor lysis syndrome (TLS) occurred following KYPROLIS administration in < 1% of patients. Patients with multiple myeloma and a high tumor burden should be considered to be at greater risk for TLS. Prior to receiving KYPROLIS, ensure that patients are well hydrated. Monitor for evidence of TLS during treatment, and manage promptly. Interrupt KYPROLIS until TLS is resolved.
KYPROLIS causes thrombocytopenia with platelet nadirs occurring around Day 8 of each 28-day cycle and recovery to baseline by the start of the next 28-day cycle. In patients with multiple myeloma, 36% of patients experienced thrombocytopenia, including Grade 4 in 10%. Thrombocytopenia following KYPROLIS administration resulted in a dose reduction in 1% of patients and discontinuation of treatment with KYPROLIS in < 1% of patients. Monitor platelet counts frequently during treatment with KYPROLIS. Reduce or interrupt dose as clinically indicated.
Hepatic Toxicity and Hepatic Failure
Cases of hepatic failure, including fatal cases, have been reported (< 1%). KYPROLIS can cause elevations of serum transaminases and bilirubin. Withhold KYPROLIS in patients experiencing Grade 3 or greater elevations of transaminases, bilirubin, or other liver enzyme abnormalities until resolved or returned to baseline. After resolution, consider if restarting KYPROLIS is appropriate. Monitor liver enzymes frequently.

Embryo-fetal Toxicity
KYPROLIS can cause fetal harm when administered to a pregnant woman based on its mechanism of action and findings in animals. There are no adequate and well-controlled studies in pregnant women using KYPROLIS. Carfilzomib caused embryo-fetal toxicity in pregnant rabbits at doses that were lower than in patients receiving the recommended dose. Females of reproductive potential should be advised to avoid becoming pregnant while being treated with KYPROLIS.


Serious adverse reactions were reported in 45% of patients. The most common serious adverse reactions were pneumonia (10%), acute renal failure (4%), pyrexia (3%), and congestive heart failure (3%). Adverse reactions leading to discontinuation of KYPROLIS occurred in 15% of patients and included congestive heart failure (2%), cardiac arrest, dyspnea, increased blood creatinine, and acute renal failure (1% each).
The most common adverse reactions (incidence ≥ 30%) were fatigue (56%), anemia (47%), nausea (45%), thrombocytopenia (36%), dyspnea (35%), diarrhea (33%), and pyrexia (30%).


Since dialysis clearance of KYPROLIS concentrations has not been studied, the drug should be administered after the dialysis procedure.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit, or call1-800-FDA-1088. For important risk and use information, please see full Prescribing Information.

Drove the 2 1/2 hours home and arrived by 2:30 PM. The roads were dry through the Craters of the Moon.
Also dry near Mackay, Idaho with snow on the MIne Hill. October 23 2012

Walked Kemmer to the Big Lost River Smelter Bridge (1.20 miles). Stopped to talk to a friend who was out looking for a photo opportunity.

1 comment:

  1. I can't help but think that your heart is strong due to your consistent mine hill hikes. Hopefully this will be an advantage during treatment.