Question: My wife has amyloidosis, congestive heart failure and multiple myeloma. She has just had her 4th treatment of Velcade. Because she is so weak and frail, our oncologist is giving her the Velcade only once per week, and in a lower than normal dose. The first four days of each month she also takes Dexamethazone. She takes 40mg of Lasiks morning and night, but still has fluid buildup. She can walk only a dozen or so steps, very slowly, before having to stop to catch her breath. She spent 2 weeks in hospital in January with severe congestive heart failure. Three thorasentises procedures were done, withdrawing some 4 liters of fluid--not infected, thank goodness.

Her blood pressure is usually around 85/60--sistolic is almost never over 100. Her heart rate is usually 110 to 130. She has Carvedilol, but can take it only if sistolic pressure is 100 or more. So rarely can take that to slow her heart rate.

Our PCP, who has treated us for 25 years and knows her very well, has suggested that we consider Hospice Care. Our thinking is to wait and see if the Velcade/Dexamethazone will help. Her Lambda light chain blood measure was 255 prior to start of Velcade. We will get another reading of that on Thursday May 2.

My questions (and I know each case is different, but need some guidance):

1. What is a reasonable prognosis or life expectation given her problems?

2. Are there other medications that should be tried?