Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission
Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.
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Explaining Relapsed Refractory Multiple Myeloma
Never in the history of multiple myeloma has it been more important and as complicated explaining relapsed refractory multiple myeloma. The analysis linked below is both complete and difficult to absorb. But is worth it for the RR/MM patient.
I have to be honest and admit that it was my watching the video linked below, of Drs. Raje, Fonseca and Anderson, that compelled me to post this blog on PeopleBeatingCancer.org.
Drs. Raje, Fonseca and Anderson Give a Thorough Look into RR/MM
Despite thoroughly explaining relapsed refractory multiple myeloma from a conventional standpoint, I have to include the fact that I myself, was RR/MM, told I was end-stage myeloma and managed to find and undergo a non-FDA approved therapy that put me into complete remission where I have stayed since early 1999.
My point is that it is in the MM patient’s interest to learn about all aspects of myeloma. Whether the patient utilizes a given therapy or not- he, she should know that there is a plan B, C, D, etc.
Email me at David.PeopleBeatingCancer@gmail.com if you have questions about any aspect of multiple myeloma.
Hang in there,
David Emerson
- Myeloma Survivor
- Myeloma Cancer Coach
- Director PeopleBeatingCancer
Relapsed/Refractory Multiple Myeloma: A Review of Available Therapies and Clinical Scenarios Encountered in Myeloma Relapse
“Multiple myeloma remains an incurable disease with the usual disease course requiring
- induction therapy,
- autologous stem cell transplantation for eligible patients,
- and long-term maintenance.
Risk stratification tools and cytogenetic alterations help inform individualized therapeutic choices for patients in hopes of achieving long-term remissions with preserved quality of life.
Unfortunately, relapses occur at different stages of the course of the disease owing to the biological heterogeneity of the disease. Addressing relapse can be complex and challenging as there are both therapy- and patient-related factors to consider.
In this broad scoping review of available therapies in relapsed/refractory multiple myeloma (RRMM), we cover the pharmacologic mechanisms underlying active therapies such as
- immunomodulatory agents (IMiDs),
- proteasome inhibitors (PIs),
- monoclonal antibodies (mAbs),
- traditional chemotherapy,
- and Venetoclax.
We then review the clinical data supporting the use of these therapies, organized based on drug resistance/refractoriness, and the role of autologous stem cell transplant (ASCT).
Approaches to special situations during relapse such as renal impairment and extramedullary disease are also covered.
Lastly, we look towards the future by briefly reviewing the clinical data supporting the use of
- chimeric antigen receptor (CAR-T) therapy,
- bispecific T cell engagers (BITE), and
- Cereblon E3 Ligase Modulators (CELMoDs).
Conclusions
Highly effective therapies for RRMM are helping to control the disease for our patients providing the benefits of improved survival and maintained the quality of life. Relapses continue to occur which is a humbling reminder that the disease remains much smarter than we are as clinicians and researchers.
We have managed to outsmart this disease in some ways by leveraging our knowledge of the heterogeneity of plasma cell clones and markers of higher-risk disease and incorporating them into treatment decision-making.
It is well established that next-generation IMIDs such as POM, next-generation PIs such as CAR and IXA, and monoclonals such as DARA, ISA, and ELO will continue to have substantial roles long term in the relapse/refractory setting. Other agents such as VEN and SELI are finding their own niche in very specific situations. Certain pillars of therapy such as ASCT and chemotherapy will continue to exist as options for the right patient in unique scenarios such as renal disease or extramedullary relapse.
There is promise on the horizon as we race toward a functional cure for myeloma patients, with novel agents such as CAR-T and BITEs showing impressive activity in the most heavy of pre-treated patients, well beyond what was seen two decades ago.
As myeloma is viewed more and more as a chronic disease, the key in assessing new therapies will be to answer questions not only related to patients’ survival and response, but also to their quality of life, reported outcomes, financial burdens, and disparities in access to care.”