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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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Low-dose Revlimid Maintenance- How Long?

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Hi David- So, I had biopsy a few weeks ago and follow up meeting with my doctor. Now, biopsy results are good (attached) and my doctor says she wants to take me off low-dose Revlimid maintenance (LDRM)  for good.

My question to you is – How about patients being taken off Revlimid two years after stem cell transplant?

I am working with a long-term myeloma survivor named Brian. Not his real name. Brian’s question above happened to be coincide with the study linked and excerpted below so I thought I would write a blog post about the issue- how long should myeloma patients stay on low-dose revlimid maintenance therapy?
As is often the case with multiple myeloma. There two very different answers. 
  1. Patients stay on low-dose revlimid maintenance until they progress (relapse) or until they can’t take the side effects any longer.
  2. Patients stay on low-dose revlimid maintenance for two years IF they remain in complete remission the entire time.

The study linked below deals specifically with the second answer. Brian is being taken off LDRM therapy because he as been in complete remission ever since he had an autologous stem cell transplant two years ago.

As you can see, I’ve written many posts about LDRM. I can think of few issues that are more important to the newly diagnosed myeloma patient. As will all conventional therapies, there are very real pros and cons with low-dose remlimid maintenance therapy.

To learn more about low-dose revlimid maintenance therapy- click the links below

Please understand that I know of few MM survivors who are able to sustain complete remission post ASCT for two years.

Have you been diagnosed with multiple myeloma? What are your symptoms? Stage? Let me know- David.PeopleBeatingCancer@gmail.com

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Immunophenotypic correlates of sustained MRD negativity in patients with multiple myeloma

“The lack of established curative therapies however leads to relapse and consequently, the current treatment paradigm is focused on using maintenance therapy to prolong and improve initial treatment response2

Members of our study team recently published the results of phase II clinical trial investigating the dynamics of minimal residual disease (MRD) during lenalidomide maintenance therapy for patients with newly diagnosed MM following unrestricted induction therapy5.

In this trial, it was demonstrated that achieving sustained MRD negativity, defined as two consecutive negative measurements at least 1 year apart during maintenance therapy, is strongly associated with prolonged PFS. It was found that compared to patients with sustained MRD negativity, patients who lost MRD negativity after one year of maintenance were 14 times more likely to progress than those who sustained MRD negativity.

In fact, patients who sustained MRD negativity for 2 years (n = 34) had no recorded disease progression at a median of 19.8 months (95% CI 15.8–22.3) past the 2-year maintenance landmark…

Since one of the mechanisms of action of lenalidomide is to enhance cell-mediated immunity by stimulating proliferation and activation of T cells and natural killer (NK) cells13, we hypothesized that the duration of the clinical response may also be driven by features of the immune microenvironment.

In support of this, a recent study focusing on myeloma precursor conditions, monoclonal gammopathy of undetermined significance (MGUS) and smoldering MM (SMM), found substantial transcriptional and compositional changes in the bone marrow microenvironment during progression from a healthy state, to precursor MM, and then active disease14.

Therefore, we conducted a comprehensive investigation of the immune landscape in patients with newly diagnosed MM receiving lenalidomide as maintenance therapy. Using longitudinally collected bone marrow and peripheral blood samples before and during lenalidomide treatment, we performed an exploratory, secondary analysis of our previously published clinical trial to elucidate the roles of the immune cell subsets and T-cell repertoire…

n summary, the host immune system is critical for the eradication of tumor cells both directly and through its interaction with immunotherapy. Through comprehensive immune profiling of the bone marrow and blood from patients with newly diagnosed MM receiving lenalidomide as maintenance, we uncovered distinct differences in immune cell composition specific to patients with sustained MRD negativity that vary according to exposure to high-dose melphalan…

Our findings support the hypothesis that the immune microenvironment influences the duration of treatment response and suggests that the immune system of patients achieving a durable remission may recover to a pre-malignant state.




Leave a Comment:

Tama Smith says 8 months ago

Why doesn’t anybody EVER talk about somebody like my husband who never had a SCT but has had perfectly normal blood work for three years? When can he stop low dose Revlimid? I can never get an answer to that, and we have two of the best doctors in the world! It’s so frustrating!! They always say studies show, your remission will last longer if you stay on maintenance drugs. Are there any studies for people who have NOT had an SCT and are in a CR?? NO. That’s why studies show you need to stay on the medication. Ugh 😩
Looking forward to hearing your thoughts!

    David Emerson says 8 months ago

    Hi Tama-

    To answer your question, 80% of clinical trials are conducted by drug companies. As you can imagine, drug companies only ask questions that they want answered. Drug companies want MM patients to have an ASCT. Your husband takes a low dose approach to his MM that they don’t like.

    To be fair to oncologists and drug companies, they don’t know the answer to your question.

    Lastly, the closest research that has come to addressing your husband’s situation is the study linked in my post yesterday. After two years of continuous low-dose rev. and two years of continuous CR, the MM patient was taken off maintenance revlimid.

    If you post your question in Beating Myeloma, I will start off the conversation by posting my reply above.

    For the record, your husband is doing WELL. He is exposing his body to a fraction of the toxicity that most MM patients do.



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