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Diagnosed with SMM, SPB, or MGUS?

Learn how you can stall the development of full-blown Multiple Myeloma with evidence-based nutritional and supplementation therapies.

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High Risk Smoldering Multiple Myeloma? To Treat or To Wait?

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A recent update confirmed an overall survival advantage after a median follow-up of more than six years,”How can overall survival be measured in pre-Multiple Myeloma (MGUS, SMM)?

The oncologist in the article below, Dr. Ola Landgren is extremely knowledgeable. When it comes to conventional multiple myeloma oncology there is no one who knows more than Dr. Lundgren.

Having said that, as we all know, doctors want to treat. That is what they do. If you have been diagnosed with smoldering multiple myeloma and your oncologist wants to treat you, meaning he or she wants you to undergo toxic chemotherapy for your SMM, ask one simple question.

Will this therapy help me live better (feel better) and longer (overall survival)? You must be clear on this. Saying, as the article does below, that SMMers with high-risk features “benefit from therapy” tells you nothing. 

Image result for images of pre blood cancer patients

Smoldering multiple myeloma is not cancer. It is pre-cancer or a stage of pre-multiple myeloma. In the interview below, when Dr. Landgren states that “A recent update confirmed an overall survival advantage after a median follow-up of more than six years,” how can overall survival be measured in pre-MM?

Or to put it another way, once a patient begins chemotherapy he/she begins progress towards MDR aka multidrug resistance. Please ask your oncologist if this will be the case.

There are evidence-based, non-conventional therapies that research shows can slow and even reverse pre-myeloma from becomeing frank MM.

To learn more about these therapies and about Pre-Myeloma conditions management, please watch the short video below:

 

Thank you,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:


Q&A: Evolving Strategies in Treatment of Smoldering MM

“A substantial body of evidence indicates that patients with smoldering multiple myeloma (SMM) who have high-risk features benefit from therapy…

Clinical Oncology News: What is the evidence so far that patients with high-risk SMM benefit from therapy?

Dr. Landgren: One of the most commonly cited studies was a randomized trial of 119 high-risk patients published in 2013 by Mateos et al (N Engl J Med 2013;369[5]:438-447, PMID: 23902483). In this study, a two-drug regimen of lenalidomide plus dexamethasone was associated with a significant progression-free survival advantage over observation. A recent update confirmed an overall survival advantage after a median follow-up of more than six years

Review Article

Smoldering Multiple Myeloma

5. Summary and Future

Currently, treatment is not recommended for SMM based on data derived from several small randomized controlled trials. However, the recent Mateos et al. trial showed improved OS with lenalidomide and dexamethasone treatment among patients with high-risk SMM. This suggested that high-risk SMM should be targeted for early intervention. However, the Mateos et al. trial had a small sample size. Much larger trials that select patients with high-risk SMM are needed to provide more evidence. The Mateos et al. trial used a combination regimen; therefore, whether the benefit was due to lenalidomide is unclear. More data were needed to isolate the effect of lenalidomide, and more trials were needed to evaluate the effect of other novel drugs which are not as expensive as lenalidomide on high-risk SMM. In addition, the criteria for high-risk SMM should be established. Mateos et al. used two separate criteria to identify high-risk SMM, one defined by Kyle et al. and another by Pèrez-Persona et al. This method was validated to identify patients who progress to active MM within almost 2 years after diagnosis. However, such criteria limit the general applicability of this approach because flow cytometry was required. Currently, a number of parameters have been described to predict risk of progression to symptomatic MM, prompting the following questions: (1) what probability of 2-year progression to symptomatic MM will be defined as high risk? (2) Which predictors should be used alone or in combination to identify high-risk SMM? Currently, there is no consensus, but it is generally accepted that patients with BMPC ≥ 60%, FLC ratio ≥ 100, or abnormal MRI (>1 focal lesion) are at high risk and need to be treated immediately. After reviewing all of the data, patients with BMPC ≥ 60%, FLC ratio ≥ 100, or abnormal MRI (>1 focal lesion) have ≥70% probability of progression to active MM (Table 3). If indeed there is a 70% probability of progression, we recommend that high PBPC also be considered as a high-risk factor.

 

 

 

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Risk of Progression for Smoldering Multiple Myeloma is Reduced...at what cost? - PeopleBeatingCancer says 3 years ago

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Why Treat Smoldering Multiple Myeloma Now?!?! - PeopleBeatingCancer says 3 years ago

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