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Curative Strategy for Smoldering Myeloma?
According to the study linked below, the aggressive chemo regimen discussed is a curative strategy for smoldering myeloma. The possibility of curing your incurable pre-cancer can be overwhelming.
First and foremost, yes, numerous studies document the ability of conventional treatment to delay progression of monoclonal proteins in SMM patients and progression to full MM. SMM responds well to treatment, on average, because the disease is relatively early stage.
One of the problems with conventional oncological thinking is that it is relatively short-term. The definition of a cure in oncology is when a given cancer disappears with treatment. As we know with MM, many patients reach remission yet the cancer always comes back. MM always relapses.
If you are considering undergoing treatment for your high-risk SMM, ask yourself:
- Is your goal to delay progression or live the longest life possible?
- Does your quality of life make a difference to you?
- Has MM ever been cured? Any stage- pre, stage 1, stage 2 or stage 3?
The definition of high-risk SMM is the patient’s risk of 50% progression for the next two years. This statistic ignores those evidence-based non-conventional therapies shown to reduce the risk of MM.
Myeloma has never been cured with chemotherapy. When it comes down to it, stage 1 MM is close to SMM. Stage 1 MM has been treated with aggressive chemotherapy for years. No one has ever been cured that I know of.
Of the 90 SMM patients enrolled in the trial below, one patient died of treatment-induced infection and two other patients developed treatment-induced secondary cancers. Do SMM patients want to risk death for less than a third of the patients remaining in uMRD at 70 months.
What is another possible therapy plan?
Upon diagnosis of SMM, begin pre-habilitation.
Remember that while there is a risk of progression, the patient may not progress to full MM and prehabilitation has been shown to enhance response if the patient does choose conventional therapies.
If the patient progresses to full MM, they will be early or stage 1 MM. Consider taking a control approach (please read the cure vs. control approach to managing MM)
Working with a MM specialist and working through the therapy classes listed below, SMM patients, on average, will achieve longer OS with a higher quality of life by controlling their MM rather than by taking an aggressive or “potentially curative approach.”
There are many possible FDA approved therapies shown to lengthen the OS of patients.
- Chemotherapy and Steroids: Traditional methods used to control the disease.
- Stem Cell Transplants: Autologous stem cell transplants (using the patient’s own cells) have been effective in extending remission periods.
- Targeted Therapy: Drugs like bortezomib (Velcade), carfilzomib (Kyprolis), and ixazomib (Ninlaro) target specific proteins in myeloma cells.
- Immunotherapy: Treatments like daratumumab (Darzalex) and elotuzumab (Empliciti) help the immune system recognize and attack myeloma cells.
- CAR-T Cell Therapy: This newer approach involves modifying a patient’s T cells to better attack cancer cells.
Remember that there are dozens of complementary therapies shown to enhance the SMM patient’s well-being and building the patient’s immune system.
man hand holding his nutritional supplemets, healthy lifestyle background.
Conventional oncology usually adheres to FDA-approved treatments and rarely, if ever, discusses complementary therapies such as
- anti-MM nutrition,
- anti-MM supplementation and
- and anti-MM lifestyle therapies.
Evidence-based non-conventional therapies can enhance immune function, enhance bone health both leading to improved quality-of-life.
In my 30-plus years as a MM survivor, I have repeatedly whitnessed oncology oversell the benefits of treatment while underselling the risks of treatment.
If you are a SMM patient curious to learn more about evidence-based therapies shown to reduce the risk of MM, email me at David.PeopleBeatingCancer@gmail.com
Thank you,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Curative Strategy for High-Risk Smoldering Myeloma: Carfilzomib, Lenalidomide, and Dexamethasone (KRd) Followed by Transplant, KRd Consolidation, and Rd Maintenance
“Purpose
Early treatment of high-risk smoldering myeloma has been shown to delay progression to multiple myeloma (MM). We conducted this trial with curative intention using a treatment approach employed for newly diagnosed patients with MM.
Methods
Patients with high-risk smoldering myeloma (>50% progression risk at 2 years) and transplant candidates were included and received induction therapy with carfilzomib, lenalidomide, and dexamethasone (KRd), six cycles, followed by high-dose melphalan (200 mg/m2) autologous stem-cell transplantation (HDM-ASCT), two KRd consolidation cycles, and Rd maintenance for 2 years.
The primary end point was undetectable measurable residual disease (uMRD) rate by next-generation flow after ASCT. Sustained uMRD 4 years after ASCT was the secondary end point.
Results
Between June 2015 and June 2017, 90 patients were included, and 31% met at least one SixtyLightchain MRI (SLiM)-
- hypercalcemia,
- renal impairment,
- anemia,
- bone disease (CRAB)
criterion. After a median follow-up of 70.1 months, 3 months after ASCT, in the intention-to-treat population, 56 (62%) of 90 patients had uMRD, and 4 years later, it was sustained in 29 patients (31%).
Five patients progressed to MM, and the 70-month progression rate was 94% (95% CI, 84 to 89). The presence of any SLiM CRAB criteria predicted progression to MM (four of the five patients; hazard ratio, 0.12; 95% CI, 0.14 to 1.13; P = .03).
Thirty-six patients showed biochemical progression, and failure to achieve uMRD at the end of treatment predicted it. The 70-month overall survival was 92% (95% CI, 82 to 89).
Neutropenia and infections were the most frequent adverse events during treatment, resulting in one treatment-related death. Three second primary malignancies have been reported.
Conclusion
Although a longer follow-up is needed, this curative approach is encouraging and more effective than active MM, with 31% of the patients maintaining the uMRD 4 years after HDM-ASCT…”