In conclusion, our study highlights the importance of early severe infections and death in the era of novel agent-based therapy in patients with NDMM. Based on our risk score, patients at high risk of early, severe infections and death can be easily identified upfront, when evaluated for the latest quadruplet induction therapies including an anti-CD38 mAb.
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Early, Non-relapse Death in Myeloma
Early, non-relapse death is possible for newly diagnosed multiple myeloma (NDMM). Even at diagnosis. According to research, infection is a leading cause of death for myeloma patients.
Further, the average myeloma patient is 69 or older therefore having a relatively weak immune system. Further still, SOC induction therapy, usually a quadruplet therapy, is a lot of toxicity and can cause infections.
It makes sense then, that newly diagnosed myeloma (NDMM) patients are given an assessment to evaluate their risk of infection and death.
According to the research article linked and excerpted below, a relatively simple and effective risk assessment has been developed to determine the risk of infection and death of NDMM patients.
Can the SOC induction therapy cause infection and death in NDMM?
While chemotherapy can be effective in treating myeloma, it is not without risks and potential side effects. Early, non-relapse death in myeloma patients can occur, and it may be associated with complications related to the disease itself or the treatment.
Some potential reasons for early, non-relapse death in myeloma patients undergoing chemotherapy include:
- Disease-related complications: Myeloma can cause various complications, such as infections, kidney problems, and bone fractures. These complications may contribute to early mortality, especially if they are severe or difficult to manage.
- Treatment-related complications: Chemotherapy can have side effects that may affect different organs and systems in the body. For example, it can suppress the bone marrow, leading to decreased production of blood cells and an increased risk of infections. Additionally, chemotherapy drugs may have toxic effects on organs, such as the kidneys or heart, which can contribute to early mortality.
- Patient-specific factors: Individual factors, such as a patient’s overall health, age, and pre-existing medical conditions, can influence the risk of complications and early mortality during myeloma treatment.
- Response to treatment: If the myeloma does not respond well to chemotherapy, or if the disease progresses rapidly despite treatment, it can impact the overall prognosis and increase the risk of early mortality.
As a survivor of myeloma who is more than aware of the short, long-term and late stage side effects caused by FDA approved “safe and effective” standard-of-care therapies, I often counsel NDMM patients the benefits of a “less is more” approach to conventional myeloma treatment.
Though toxic therapies such as chemo and radiation may be necessary to both stabilize and manage the patient’s myeloma, I encourage many different evidence-based non-conventional therapies such as:
- frequent, moderate exercise,
- clean nutrition
- nutritional supplementation
- sleep, mediation, etc.
and other complementary therapies in an effort to boost the patient’s immune system at every stage of his/her treatment.
Have you been diagnosed with multiple myeloma? Are you over 69, have advanced disease or have any co-morbidities?
Let me know- David.PeopleBeatingCancer@gmail.com
Thanks and hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Predictors of early morbidity and mortality in newly diagnosed multiple myeloma: data from five randomized, controlled, phase III trials in 3700 patients
“Early morbidity and mortality affect patient outcomes in multiple myeloma. Thus, we dissected the incidence and causes of morbidity/mortality during induction therapy (IT) for newly diagnosed multiple myeloma (NDMM), and developed/validated a predictive risk score.
We evaluated 3700 transplant-eligible NDMM patients treated in 2005–2020 with novel agent-based triplet/quadruplet IT.
Primary endpoints were severe infections, death, or a combination of both. Patients were divided in a training (n = 1333) and three validation cohorts (n = 2367). During IT, 11.8%, 1.8%, and 12.5% of patients in the training cohort experienced severe infections, death, or both, respectively.
Four major, baseline risk factors for severe infection/death were identified:
- low platelet count,
- ISS III,
- higher WHO performance status,
- and age (>60 years).
A risk score (1 risk factor=1 point) stratified patients in
- low (39.5%; 0 points),
- intermediate (41.9%; 1 point),
- and high (18.6%; ≥2 points) risk.
The risk for severe infection/death increased from 7.7% vs. 11.5% vs. 23.3% in the low- vs. intermediate- vs. high-risk groups (p < 0.001). The risk score was independently validated in three trials incorporating quadruplet IT with an anti-CD38 antibody.
Our analyses established a robust and easy-to-use score to identify NDMM patients at risk of severe infection/death, covering the latest quadruplet induction therapies…