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Bispecific Infection Risk in Myeloma
Bispecific infection risk in myeloma patients is a serious health risk, according to the studies linked below. The top article cites the need for all MM patients undergoing bispecifics to be given IVIG therapy as a prophylactic measure.
While IVIG therapy does reduce the infection risk in MM patients undergoing bispecifics, I am including evidence-based non-conventional therapies shown to enhance immune function.
Infections following anti-BCMA bispecific antibodies for multiple myeloma
What evidence-based non-conventional therapies have been shown to enhance immune health?
Several evidence-based non-conventional therapies can enhance immune health. These include acupuncture, specific nutritional supplements like Vitamin D and zinc, stress-reducing practices like yoga and meditation, and even music therapy. Furthermore, practices like cupping and chiropractic care have shown promise in modulating immune responses.
Here’s a more detailed look at some of these therapies:
1. Acupuncture and Moxibustion: Acupuncture, a component of Traditional Chinese Medicine, and moxibustion (a technique using heat from burning mugwort) have shown potential in strengthening the immune system.
2. Nutritional Supplements:
3. Stress Management Techniques:
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Yoga:
Yoga, with its combination of physical postures, breathing exercises, and meditation, can help reduce stress and improve immune function by increasing natural killer cell activity and reducing inflammation.
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Meditation, particularly mindfulness-based practices, can lower stress hormones and potentially enhance immune responses.
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Music Therapy:
Music therapy has shown promise in reducing stress hormones, improving mood, and supporting immune function.
4. Other Therapies:
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Cupping, an ancient practice, may improve circulation, reduce inflammation, and activate the immune system.
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Chiropractic adjustments have been linked to improved immune function, potentially by reducing inflammation and enhancing the production of immune-related substances.
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Certain Ayurvedic preparations have shown promise in enhancing the immune system, though further research is needed to fully understand the mechanisms involved.
Important Considerations:
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Evidence base:
While many of these therapies have shown promise, it’s crucial to note that the evidence base for some is still developing. It’s recommended to consult with a qualified healthcare professional to determine the most appropriate and safe approach for your individual needs.
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Integration with conventional medicine:
Many of these therapies can be used alongside conventional medical care to provide a more holistic approach to health and well-being.
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Safety and quality:When considering nutritional supplements or herbal remedies, it’s essential to ensure that they are high-quality and sourced from reputable suppliers.
I am a long-term MM survivor. Experience has taught me that while conventional, FDA-approved therapies like IVIG therapy are important in the management of MM, non-conventional therapies have their place in MM therapy as well.
Email me at David.PeopleBeatingCancer@gmail.com to learn more about managing MM with both conventional and non-conventional therapies.
Good luck,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
IVIG prophylaxis should be initiated following bispecific antibody therapy in multiple myeloma regardless of IgG levels
“Bispecific antibodies (bsAbs) such as:
- teclistamab,
- elranatamab,
- linvoseltamab,
- and talquetamab
have impressive efficacy in multiple myeloma (MM) but come with substantial infectious risks that do not dissipate over time. Immunoglobulin replacement therapy (IgRT), which includes intravenous immunoglobulin (IVIG) and subcutaneous immunoglobulin (SCIG), may lower these risks.
In this Viewpoint, we contrast primary IgRT prophylaxis (initiation regardless of IgG levels) with preemptive IgRT treatment (initiation only once IgG levels fall below a certain threshold) in this setting.
We make evidence-based arguments for primary prophylaxis as a safer and simpler approach compared to preemptive IgG-guided IgRT.
We also discuss strategies to improve the cost-effectiveness of IVIG and SCIG across the world. Given the overwhelmingly favorable benefit-risk profile of IgRT coupled with the limitations inherent to IgG measurements in MM, withholding IgRT access based on arbitrary IgG thresholds is neither scientifically sound nor clinically appropriate for patients with MM receiving bsAb therapy…”
Infections following bispecific antibody therapy in MM: incidence and characteristics
Bispecific antibodies are becoming increasingly central in the treatment of many patients with relapsed/refractory multiple myeloma (RRMM). However, an increased risk of severe infection, including those resulting in death, has been reported from emerging clinical trials of bispecific antibodies.
An understanding of the nature of infection, including localization, pathogens, and risk factors, is vital to better manage these infections, improve survival, and improve patient quality of life…
Methods
- Patients treated with bispecific antibody therapies were retrospectively assessed for subsequent infections.
- Data were collected on patient characteristics, localization, prophylaxis, and prior treatment, and analyzed for association with infection incidence and severity.
Results
Incidence of infection
- A total of 229 patients treated with bispecific antibodies were included (Figure 1).
- 234 infections were recorded, with 123 (53%) of these at Grade 3 or higher.
- The hospitalization rate was 56%, with 13% resulting in admission to the intensive care unit and 9% in death.
- Across all patients, the incidence of first infection was 70%:
- 73% in patients treated with B-cell maturation antigen (BCMA)-directed therapies; and
- 51% in patients treated with G-protein-coupled receptor class C group 5 member D (GPRC5D)-directed therapies.
- All infections of Grade 4 or 5, as well as those requiring admission to intensive care, were identified in patients treated with BCMA-directed bispecific antibodies.
Bispecific infection risk in myeloma Bispecific infection risk in myeloma Bispecific infection risk in myeloma