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Treatment Name: ERd (Elotuzumab (Empliciti®) + Revlimid® + dexamethasone)
ERd (Elotuzumab (Empliciti®) + Revlimid® + dexamethasone) is a Chemotherapy Regimen for Multiple Myeloma (MM)
How does ERd work?
Each of the medications in the ERd chemo regimen are designed to kill or slow the growth of multiple myeloma cells. ERd may also work to enhance your immune system to help kill myeloma cells.
E – Elotuzumab (Empliciti®)
R – Revlimid® (lenalidomide)
d – Dexamethasone (Decadron®)
Alternative names: ELd, Elo-Rev-dex, Elo-Len-dex
Goals of therapy:
ERd is not given to cure multiple myeloma, but it may slow the progression of myeloma and decrease symptoms from the disease.
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Schedule
Cycles 1 and 2:
- Pre-medications: acetaminophen, ranitidine, diphenhydramine all given 30 to 90 minutes before elotuzumab (Empliciti)
- Elotuzumab intravenous (I.V.) infusion on Days 1, 8, 15, and 22
- Lenalidomide 25 mg capsule by mouth daily for 21 days continuously, on Days 1 through 21
- Dexamethasone (Dex):
- On days with elotuzumab I.V.: Dex 28 mg (seven 4 mg tablets) by mouth on Days 1 and 15, PLUS Dex 8 mg I.V. on Days 1 and 15
- On days without elotuzumab I.V.: Dex 40 mg (ten 4 mg tablets) by mouth on Days 8 and 22
- Take Dex between 3 and 24 hours before elotuzumab I.V. infusion
Cycles 3 and on:
- Elotuzumab I.V. infusion on Days 1 and 15
- Lenalidomide 25 mg capsule by mouth daily for 21 days continuously, on Days 1 through 21
- Dexamethasone (Dex):
- On days with elotuzumab I.V.: Dex 28 mg (seven 4 mg tablets) by mouth on Days 1 and 15, PLUS Dex 8 mg I.V. on Days 1 and 15
- On days without elotuzumab I.V.: Dex 40 mg (ten 4 mg tablets) by mouth on Days 8 and 22
- Take Dex between 3 and 24 hours before elotuzumab I.V. infusion
Estimated total infusion time for this treatment:
Up to 4 hours for Cycle 1, Day 1 because of the possibility of experiencing infusion reactions with elotuzumab; as short as two hours for the remaining treatment days if elotuzumab is well tolerated.
Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and I.V. fluids, such as hydration, may add more time.
Lenalidomide is a human teratogen. In order to decrease the risk of embryo-fetal exposure, lenalidomide is available only through a restricted distribution program (Revlimid® REMS).
The elotuzumab portion of the ERd regimen is usually given in an outpatient infusion center, allowing the person to go home afterwards. It is repeated every 28 days. This is known as one Cycle. Each cycle may be repeated until the regimen no longer works or until unacceptable side effects occur.
Click here for the common ERd starting doses.
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Side Effects
In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported side effects of ERd are shown here:
- Low red blood cells [anemia] (96%)
- Low platelets [thrombocytopenia] (84%)
- Low white blood cells [neutropenia] (82%)
- Fatigue (47%)
- Diarrhea (47%)
- Fever (37%)
- Constipation (36%)
- Cough (31%)
- Muscle spasm (30%)
- Back pain (28%)
- Fluid accumulation in arms or legs (26%)
- Sore throat or sinus infection (25%)
- Trouble sleeping (23%)
Infusion reactions due to elotuzumab such as fevers, chills, and high blood pressure occur in approximately 10% of patients. These infusion reactions are typically not severe, occur most commonly during the first infusion, and often resolve within 25 minutes (range 5 to 70 min) when the infusion is stopped temporarily.
On average, 9% of patients discontinue treatment due to unacceptable side effects.
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Monitoring
How often is monitoring needed?
Labs (blood tests) may be checked before treatment and periodically during treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), common multiple myeloma labs, plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked before treatment and then periodically during treatment to assess how the chemotherapy is working. Imaging may include: bone surveys, X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI), or positron emission tomography (PET) scans.
How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue ERd as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.
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ChemoExperts Tips
- Premedications such as diphenhydramine (Benadryl®), ranitidine (Zantac®) or famotidine (Pepcid®), acetaminophen (Tylenol®), and dexamethasone (Decadron®) may be given before I.V. elotuzumab to help avoid infusion related reactions. A dose of I.V. dexamethasone is given in addition to the oral dose taken at home
- A dosage reduction in lenalidomide (Revlimid®) may be required in certain individuals to help decrease side effects
- A medication to prevent blood clots is usually recommended for patients receiving ERd. The exact medicine used may differ from patient to patient and will be chosen by your doctor
- Additional medications that may be prescribed include Bactrim® (Sulfamethoxazole/Trimethoprim; unless you have a sulfa allergy) to prevent Pneumocystis Pneumonia and omeprazole (Prilosec®, or a similar medication) to prevent ulcers from dexamethasone
- Treatment with ERd may increase your risk of developing a secondary cancer including leukemia, lymphoma, and various types of solid tumors
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for multiple myeloma. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for ERd (Elotuzumab (Empliciti®) + Revlimid® + dexamethasone), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for ERd (Elotuzumab (Empliciti®) + Revlimid® + dexamethasone). Depending upon your income, they may be able to help cover the cost of:
- Elotuzumab
- Revlimid®
- Dexamethasone
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as ERd (Elotuzumab (Empliciti®) + Revlimid® + dexamethasone) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
Emotional Wellness
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with ERd (Elotuzumab (Empliciti®) + Revlimid® + dexamethasone)