Up First, Boston…

I had my visit with the Docs from DFCI today to review my current status, post transplant, and to discuss next steps.  Now, if you remember, there were two varying opinions as to my direction with respect to the transplant.  DFCI wanted a full four rounds of RVD (referred today as “cybordene” or similar), followed by a new harvest, then the transplant and then consolidation.  Mt Sinai had a differing opinion saying that we can see the chemo sensitivity when I was put on the Prednisone.  For that reason, let’s go straight to the transplant.  If things don’t go as planned we’ll consider consolidation.

When I last saw Mt Sinai I asked about next steps to which Dr J paused and offered to get Dr R’s opinion first, then we’ll discuss.  So I guess Boston is up first!  Their recommendations (and I’ve already got my opinions but will hold my comments till later) are as follows:

• Do an RVD type consolidation – around 2 to 3 cycles
• go on a Rev and Velcade maintenance 
• keep Velcade sub cutaneous (less p/n)

We also discussed new drugs.  Daratumumab and Ibrutinib are both very new and since I currently have no disease I wouldn’t be able to get these drugs (I don’t fit on any of the trials).  Pomalyst is good but I’m not relapsed yet so he wouldn’t consider it.  Kyprolis is good but velcade is better as it has less side effects on cardio pulmonary systems.   If Velcade wasn’t working then Kyprolis is a solution, but if Velc is still working then that would be the way to go at this time.