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Chemo for Smoldering Multiple Myeloma???
“Nonhematologic grade 3 adverse events occurred in 21 smoldering multiple myeloma patients (38.9%) and included thromboembolism, rash, and lung infection, with no grade 4 events.”
Yes, chemotherapy can slow the progression of smoldering multiple myeloma (SMM) to full MM. And yes, chemotherapy can put the patient in MDR status. These outcomes are terrific.
At the same time, please understand that the chemotherapy regimen cited in the research linked and excerpted below is a lot of chemotherapy. And therefore a lot of toxicity.
The study results cite non-hematologic grade 3 adverse events. Discussion of hematologic adverse events is conspicuously absent. I do not believe that no patients experience adverse events such as:
- neutropenia
- anemia
- thrombocytopenia
Not to mention long-term and late stage side effects such as chemotherapy-induced cardiomyopathy, chemotherapy-induced aging and treatment-related secondary cancers.
My point is that SMM patients should understand their risks and rewards. Yes, conventional oncology can reduce your risk of SMM becoming full MM. However you are undergoing a lot of chemotherapy and you will experience all of the short-term side effects that come with chemotherapy as well as the long-term and late stage effects that are discussed as possible adverse events.
Also, please remember that SMM is not cancer. It is a “blood disorder” that evidence-based non-conventional therapies have shown, can be managed. For example, curcumin, an evidence-based, non-toxic, non-conventional nutritional supplement shown to kill monoclonal antibodies, can also slow the progress of SMM becoming full MM.
Once you understand your risks and rewards, you are prepared to decide for yourself. If you have any questions, scroll down the page, post a question or comment and I will reply to you ASAP.
Thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Recommended Reading:
PeopleBeatingCancer- Side Effects Program
Carfilzomib, Lenalidomide, and Dexamethasone Followed by Lenalidomide Maintenance for Prevention of Symptomatic Multiple Myeloma in Patients With High-risk Smoldering Myeloma
“Importance High-risk smoldering myeloma has a 5-year risk of progression to symptomatic multiple myeloma of approximately 75%. Treatment with lenalidomide decreases the risk of progression; however, novel triplet regimens are superior, and earlier disease may be more treatment sensitive.
Objective To evaluate the use of carfilzomib, lenalidomide, and dexamethasone (KRd) with lenalidomide maintenance therapy as early intervention in high-risk smoldering myeloma and to determine the rates of minimal residual disease (MRD)–negative complete response (CR).
Design, Setting, and Participants In this single-arm, single-center, phase 2 nonrandomized controlled trial, responses were evaluated at every cycle during KRd treatment and every 3 cycles subsequently. Bone marrow biopsies and imaging were performed by cycle 8 and then annually. The study enrolled patients from May 29, 2012, to July 23, 2020, at the National Institutes of Health Clinical Center, a highly specialized tertiary cancer center. Patient key eligibility criteria included a diagnosis of high-risk smoldering myeloma based on the Mayo Clinic, Spanish, and/or Rajkumar, Mateos, and Landgren criteria.
Interventions Patients received eight 4-week cycles of intravenous carfilzomib 36 mg/m2 (first 2 doses, 20 mg/m2), dexamethasone (20 mg, cycles 1-4; 10 mg, cycles 5-8 twice weekly), and lenalidomide 25 mg (days 1-21) followed by twenty-four 28-day cycles of maintenance lenalidomide 10 mg (days 1-21). Stem cell harvest and storage were optional.
Main Outcomes and Measures The primary outcome was the MRD-negative CR rate. Key secondary outcomes included duration of MRD-negative CR and progression to multiple myeloma.
Results A total of 54 patients (median age, 59 years [range, 40-79 years]; 30 men [55.6%]; and 2 Asian [3.7%], 15 Black [27.8%], 1 Hispanic [1.9%], and 36 White [66.7%] patients) were enrolled, with a median potential follow-up time of 31.9 months (range, 6.7-102.9 months).
The MRD-negative CR rate was 70.4%, with a median sustained duration of 5.5 years. The 8-year probability of being free from progression to multiple myeloma was 91.2%, and no deaths occurred.
Nonhematologic grade 3 adverse events occurred in 21 patients (38.9%) and included thromboembolism, rash, and lung infection, with no grade 4 events.
Conclusions and Relevance Results of this phase 2 nonrandomized controlled trial suggest that treatment of high-risk smoldering myeloma with novel triplet regimens, such as KRd and lenalidomide maintenance therapy, may alter the natural history of smoldering myeloma by significantly delaying development of end-organ disease. Randomized clinical trials are needed to confirm this favorable benefit-to-risk profile.
Chemo for High Risk Smoldering Myeloma- Pain…
“…among the lenalidomide-treated patients, grade 3 or 4 hematologic and nonhematologic adverse events occurred in 36 patients (41%), with nonhematologic adverse events occurring in 25 patients (28%).”
Safety- Adverse events are listed in Tables 3 and 4. In the phase II run in, 44 patients were evaluable for adverse events. Grade 3 or 4 hematologic and nonhematolgic treatment-related adverse events occurred in 20 patients (45%), with nonhematolgic adverse events occurring in 15 patients (34%). Among the phase II patients who were off treatment (n = 35), 34% (n = 12) came off therapy as a result of adverse events. One death from pulmonary embolism occurred during the study and was determined to be therapy related…
In the randomized trial, among the lenalidomide-treated patients, grade 3 or 4 hematologic and nonhematologic adverse events occurred in 36 patients (41%), with nonhematologic adverse events occurring in 25 patients (28%). Among the phase III patients who were off treatment (n = 45), 40% (n = 18) came off therapy as a result of adverse events. Patients off treatment as a result of adverse events did not seem to have shortened PFS follow-up as evidenced by PFS follow-up extending well beyond the duration of delivered therapy…
The cumulative incidence of invasive second primary cancers at 4 years was 4.9% in the phase II run in. In the randomized trial, the 3-year CI of invasive second primary cancers was 5.2% in the lenalidomide arm and 3.5% in the observation arm (Appendix Table A7, online only)…”