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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According to research, as many MM patients die from their cancer as die from infection. infection and multiple myeloma are both long-term challenges. Both the cancer itself as well as immunotherapy damage cause immunodeficiency. MM patients undergo course after course of chemo regimens causing exhausted immune systems.
If myeloma survivors succumb to infection as often as the succumb to their myeloma, what is the myeloma survivor to do?
How does immunotherapy weaken the immune system of myeloma patients?
1. Immune Exhaustion
Immunotherapy stimulates the immune system to fight cancer, but prolonged stimulation can lead to immune exhaustion. T-cells, which are critical for fighting infections, may become overworked and lose their effectiveness, resulting in a diminished capacity to respond to other threats, including infections.
2. Lymphodepletion
Certain types of immunotherapies, such as CAR-T cell therapy or monoclonal antibodies, often require lymphodepletion before treatment. Lymphodepletion is the process of reducing the number of lymphocytes (a type of white blood cell) to make space for the new immune cells or to increase the effectiveness of the treatment. This depletion temporarily weakens the immune system, making patients more susceptible to infections and other illnesses.
3. Cytokine Release Syndrome (CRS)
Some immunotherapies, particularly CAR-T cell therapy, can trigger a massive release of cytokines, known as cytokine release syndrome (CRS). This immune overactivation can cause widespread inflammation and organ damage. To control this, doctors may use drugs (like corticosteroids or IL-6 blockers) that suppress the immune system, inadvertently weakening it.
4. Myelosuppression
Immunotherapies can also affect the bone marrow, which produces blood cells, including white blood cells that are key to fighting infections. Some treatments may cause myelosuppression, reducing the production of healthy immune cells and leaving the patient vulnerable to infections.
5. Targeting of Normal Plasma Cells
Multiple myeloma originates from plasma cells, a type of immune cell. Some immunotherapies, such as bispecific T-cell engagers (BiTEs) or monoclonal antibodies (e.g., daratumumab), target CD38 or BCMA, markers found on both cancerous and normal plasma cells. In destroying cancer cells, these therapies may also deplete healthy plasma cells, impairing the patient’s ability to produce antibodies, which are essential for fighting infections.
6. Autoimmunity and Inflammation
Some immunotherapies can overstimulate the immune system to the point where it begins attacking healthy tissues (autoimmunity). This overreaction can damage immune cells and organs, further weakening the immune response to infections or other diseases.
Management and Monitoring
To mitigate these effects, doctors carefully monitor patients undergoing immunotherapy for signs of immune suppression and infections. Prophylactic treatments, like antibiotics or antivirals, are often given, and immunoglobulin (antibody) replacement therapy may be used to boost immune function if antibody levels fall too low.
In summary, while immunotherapy can be highly effective in targeting myeloma cells, its effects on both cancerous and normal components of the immune system can lead to a weakened immune state.
“A common characteristic of multiple myeloma (MM) is the dysfunction of patients’ immune system, a condition termed immunosuppression. This state is mainly due to alterations in the number and functionality of the principal immune populations.
In this setting, immunotherapy has acquired high relevance in the last years and the investigation of agents that boost the immune system represent a field of interest.
In the present review, we will summarize the main cellular and molecular alterations observed in MM patients’ immune system. Furthermore, we will describe the mechanisms of action of the four immunotherapeutic drugs approved so far for the treatment of MM, which are part of the group of monoclonal antibodies (mAbs).
Finally, the immune-stimulating effects of several therapeutic agents are described due to their potential role in reversing immunosuppression and, therefore, in favoring the efficacy of immunotherapy drugs, such as mAbs, as part of future pharmacological combinations…
Additionally, it is of utmost importance to discern the immune-stimulating mechanisms of the drugs described above in the context of MM, principally of those for which controversial data have been reported as HDACi, and of the most novel ones (i.e., arginase inhibitors, IDO inhibitors, etc.).
In line with this, new preclinical studies and clinical trials currently ongoing with some of them will help to elucidate their real perspectives as antimyeloma agents, and especially their capacity to potentiate the efficacy of immunotherapeutic mAbs…”
“One study found that 45% of early deaths in multiple myeloma happened because of infections – not the cancer itself. So it’s important for you to know what steps to take to protect yourself against infection…
As myeloma treatments have gotten better, more people with myeloma are living longer. Multiple myeloma today has become a chronic condition. You may get better for a while and then relapse. Your immune system may get weaker over time. So finding ways to manage any problems with your immune system and your risk for infection is key to doing well…”
Thank you for this post. I am always concerned about infection. I wear a mask when out in most case and avoid large crowds. But is this enough, I’m almost at the point of excessive. I pay attention to everything and everybody. Status post SCT 15 months and have done well. Some fatigue and the gut is the most bothersome. My maintenance consists of monthly Darzalex and Lenalidomide 5mg, 2 weeks on and 1 week off.
