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Do you agree with my decision not to undergo chemo? Multiple Myeloma Q & A

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Hi David- I was diagnosed with Multiple Myeloma in 2014. My biggest symptoms are fatigue and occasionally bone pain, and peripheral neuropathy.the first year they gave me Zometa to prevent brittle bones for the first year. Then they decided to watch and wait because my cancer was slumbering

My (MM) lab numbers have remained stable and my symptoms have remained the same with occasional nausea. My oncologist thinks I should start chemo. I told him no. I feel as close to normal as I could get. 

I am already at high risk for covid-19 being that I’m old, diabetic with heart problems and asthma, chemo will devastate me putting me at higher risk.

Do you agree with my decision not to undergo chemo? Lisa

Hi Lisa-

Just to confirm, you were diagnosed with MM in 2014. You underwent chemotherapy and reached remission? 

When you refer to your “symptoms,” are you saying that the side effects from chemotherapy are: 

  • fatigue
  • occasional bone pain
  • peripheral neuropathy

Talking about MM via email can be difficult so I’m making sure I understand your situation. 

When you say that your lab numbers have remained the same, I interpret you saying that you have remained in remission, remained stable since you completed chemotherapy back in 2014? 

If this is the case then you have done well. A six year PFS (progression-free survival aka first remission) is well beyond the averages. 

Regarding your question:

“Do you agree with my decision not to undergo chemo?”

My answer to your question depends on your situation. Let me explain. 

I feel as close to normal as I could get.”

You are talking about your quality-of-life when you say this. Or I should say that you fear that undergoing more chemo might make you feel…not so normal…

“I am already at high risk for covid-19 being that I’m old, diabetic with heart problems and asthma, chemo will devastate me putting me at higher risk.”

  1. Dexamethasone increases blood glucose. Dex. would probably be part of undergoing chemo again. 
  2. Chemo usually causes a drop in red and/or white blood cells (myelosuppression). You are correct in that myelosuppression would make you more susceptible to covid. And if your blood cells dropped and you contracted covid, you would be more likely to die. 
  3. Several chemotherapy regimens are cardiotoxic. They cause heart damage. 

My replies 1-3 support you NOT undergoing chemo. Now I will make an argument FOR doing chemo. 

The case for more chemotherapy comes down to your diagnostic testing results. You can slowly begin to relapse without requiring more chemo. 

  1. What is your m-spike aka monoclonal protein?
  2. What are your levels of immunoglobulins, freelight chains? 
  3. Lastly, when was the last time you had some sort of imaging study? MRI, PET, CT, etc.? Are you at risk of bone damage? 

I would prefer to give you one simple answer to your question but, as you can read, it isn’t that easy. 

Depending on how much MM is in your blood stream, consider low-dose therapy such as 5 mg of revlimid (lenalidomide). Revlimid has been shown to work synergistically aka integrate with curcumin. 

I will link the elderly MM CC guide below. 

I will be more specific is you can answer the questions above. 

For the record, your oncologist will say much the same thing if you break down your thinking above. 

Let me know- thanks. 

Hang in there, 

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Consider These 3 Things Before Determining Myeloma Treatment

“Many patient factors must be considered before deciding on a treatment regimen for patients with relapsed/refractory multiple myeloma…

“Many triplet options exist. You have to pay attention to the previous drugs that patients received and that kind of responses they had to them. [You want to know whether] patients had any drug-free intervals from specific drug classes, [so you can] pair them with the right 3-drug combination,” he explained in a recent interview with OncLive, a sister publication of Oncology Nursing News.

“There are situations where we start off with 2-drug combinations, especially in older, frail patients, and then consider the addition of a third drug. It’s more art than science [in that scenario,”

Patient-related factors that should be considered include age, comorbidities, socioeconomic support, and where the individual lives.

“These factors play a role in routes of administration and the kind of schedule you set up,” Usmani said.

Additionally, disease-related factors include:

  • how aggressive the relapse is
  • if the progression is a slow biochemical relapse
  • if the patient is clinically symptomatic
  • are they presenting with circulating plasma cells or extramedullary disease
  • is there any renal failure
  • does the patient have other high-risk genomic features on their karotypic analysis

How I treat elderly patients with myeloma

“The clinical approach to older patients with myeloma has to be modified to take into account comorbidities and the likelihood of higher treatment-related toxicity.

Individualization of management and adequate supportive therapy are important to obtain the best response while minimizing adverse effects. Corticosteroids, novel agents, conventional cytotoxic agents, and high-dose chemotherapy with autotransplantation (modalities used in younger patients) are also used in older patients, although the elderly undergo transplantation less frequently. The sequential use of active agents singly and in different combinations has improved response rates and survival of all patients with myeloma, including the elderly…”

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