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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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Low-Dose Revlimid Maintenance Post Autologous Stem Cell Transplant- Pros/Cons

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“Serious adverse events were reported in 494 (45%) of 1097 patients receiving lenalidomide compared with 150 (17%) of 874 patients on observation…”

Hello David- I posted a comment a few months ago. My multiple myeloma diagnosis led to an ASCT and low-dose Revlimid maintenance therapy (LDRMT) since June 2019 although my doctor told me I am in complete remission since april of same year.

After the usual Bortezomib -cortizone- preparation therapy once a week for 4 months, I underwent a heavy Melphalan autologous cell transplant…which got rid of all remaining cancer

My wife and I are pronatural,…organic…glutenfree etc advocates.

Some people say  that Revlimid is useless since I already am in total …remission.
As you also know, doctors and pharmacists alike say that antioxydants are a no go when undergoing anti cancer conventional therapies..

Thank you for your input regarding the latests remarks. Regards, Matt

 


Hi Matt-

Thanks for reaching out. Your situation helps me illustrate the pros and cons of low-dose revlimid maintenance therapy (LDMRT) post ASCT.

Congratulations on reaching complete remission following your RVD induction therapy and autologous stem cell transplant.

Because your comments didn’t stipulate if you are high risk or not, I included both in the research excerpted below.

I chose the study below because:

  1. it is relevant (induction triplets are different from you but the ASCT is melphalan  based)
  2. it is current (published 12/2018)
  3. the research seems to apply directly to your situation- induction, ASCT, low-dose revlimid maintenance therapy-

As I see them, the pros and cons of low-dose revlimid maintenance are:

  • LDMRT provides superior progression-free survival (time of first remission) compared to observation-
  • LDMRT provides similar overall survival (length of life) in the study below but I’m pretty sure that other studies document a longer average OS for LDMRT-
  • LDMRT does result in a much greater risk of serious adverse events aka side effects. More chemotherapy means more toxicity which results in more damage to the patient.

It is the increased risk of side effects that have always been my problem with conventional MM chemotherapy. For the record, the study below doesn’t just document side effects, it documents serious grade 3 and 4 adverse events.

Grade 3 and 4 side effects are serious health problems. Secondary cancers, myelosuppression,  even death.

It is the greater risk of serious side effects that cause me to encourage LDMRT but try to reduce toxicity in any way possible including:

  • speak to your oncologist about lowering the dose of revlimid- 
  • add evidence-based, integrative therapies shown to enhance the efficacy of revlimid while reducing toxicity
  • add evidence-based complimentary therapies such as exercise, detox., anti-angiogenic nutrition/supplementation, etc. 

The solution Matt, for me at least, has always been to take the best of both conventional MM therapy and combine it with evidence-based, non-conventional therapies.

Keep in touch and let me know how your MM therapies progress.

Thanks,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:


Lenalidomide maintenance versus observation for patients with newly diagnosed multiple myeloma (Myeloma XI): a multicentre, open-label, randomised, phase 3 trial

“Patients with multiple myeloma treated with lenalidomide maintenance therapy have improved progression-free survival, primarily following autologous stem-cell transplantation.

A beneficial effect of lenalidomide maintenance therapy on overall survival in this setting has been inconsistent between individual studies.

Minimal data are available on the effect of maintenance lenalidomide in more aggressive disease states, such as patients with cytogenetic high-risk disease or patients ineligible for transplantation.

We aimed to assess lenalidomide maintenance versus observation in patients with newly diagnosed multiple myeloma, including cytogenetic risk and transplantation status subgroup analyses…

After a median follow-up of 31 months, median progression-free survival was

  • 39 months with lenalidomide and
  • 20 months (18–22) with observation,

and 3-year overall survival was

  • 78·6% in the lenalidomide group and
  • 75·8% in the observation group.

Progression-free survival was improved with lenalidomide compared with observation across all prespecified subgroups.

By cytogenetic risk group, in standard-risk patients,

  • 3-year overall survival was 86·4% in the lenalidomide group compared with
  • 81·3% in the observation group,

and in high-risk patients, it was

  • 74.9% in the lenalidomide group compared with
  • 63·7% in the observation group;

and in ultra-high-risk patients it was

  • 62·9%  compared with
  • 43·5%.

Since these subgroup analyses results were not powered they should be interpreted with caution.

The most common grade 3 or 4 adverse events for patients taking lenalidomide were haematological, including

  • neutropenia,
  • thrombocytopenia, and
  • anaemia.

Serious adverse events were reported in 494 (45%) of 1097 patients receiving lenalidomide compared with 150 (17%) of 874 patients on observation…”

 

 

 

Leave a Comment:

4 comments
Seshan S Sarma says last year

Hello David,

First of all thank you for the effort in sharing and educating folks on MM. I was diagnosed with MM in Mar 2020. After the standard VRD induction, I underwent HDM based ASCT in Dec. The first ASCT was successful and I was in CR. However, I have a high risk MM. The doctors advised a tandem. I underwent a second transplant in April. My second transplant was Super Beam regimen. Currently home and recovering. I’m hoping for a full recovery and CR.

In prep for post transplant, I wanted to reach out for the thought on Revlamid maintenance. I’m 48 years old. All the studies show a better PFS to be on Revlamid Maintenance. But there is information based on age.

Given my age, tandem transplant and CR, can you share your thoughts on maintenance therapy.

Many thanks in advance for your time and guidance.

Thanks
Seshan Sarma

Reply
    David Emerson says last year

    Hi Seshan-

    I am sorry to read of your MM diagnosis however it seems as if you are treating your MM aggressively and it seems as if you have researched your situation thoroughly.

    Having had few questions about the “Super-Beam therapy,” I thought I should link and excerpt some info. My thinking is that the “super-beam therapy” is the ASCT procedure that the University of Arkansas (Little Rock) pioneered under Bart Barlogie?

    Also, when you say that you are “high-risk” it means that you have genetic abnormalities that are the reason why you chose to have the second ASCT?

    If this is correct, my thinking is that this procedure is

    very aggressive- much toxicity but you are young and high risk-
    high risk, high return meaning possible long PFS and possible OS
    genetic abnormalities can present a sort of wild card or unknown outcome for your situation…

    The short answer to your question about low-dose Revlimid maintenance therapy is that it depends on your response to the Super-Beam Therapy meaning, how deep is your CR (complete remission). You didn’t mention MRD negative or positive status…

    Since that answer doesn’t provide much information for you I will elaborate further.

    In my experience, conventional MM focuses on the short-term. By short-term I’m talking 3, 4 maybe five years, maximum. You have achieved a complete response which is ideal. However,

    there are a number of studies that cite the possible late stage side effects that can come with the amount of chemotherapy that you’ve had.
    according to research, maintenance therapy does not provide gains in OS (overall survival aka length of life)

    My point is that at 48, you have treated your high-risk MM aggressively which will hopefully result in a long PFS. But more toxicity will not result in longer OS and my increase your risks of long-term and late stage side effects.

    Let me know if you have any questions. Good luck,

    David Emerson

    “While maintenance or continuous therapy with Revlimid is the current standard of care for patients with standard-risk myeloma, sub-group analyses of high-risk patients in clinical trials has established that Revlimid maintenance does not prolong overall survival for many patients with high-risk cytogenetic …”

    Super (S)-Beam for Advanced and Refractory Multiple Myeloma (ARMM)
    https://www.researchgate.net/publication/336481252_Super_S-Beam_for_Advanced_and_Refractory_Multiple_Myeloma_ARMM

    “Background- Despite availability of novel agents, many MM patients still relapse and require salvage interventions. In the Arkansas program, we have attempted to procure initially sufficient hematopoietic precursor cells, for use in high-dose therapy salvage regimens once phase I-II trials have been exhausted.

    We are reporting on the efficacy in terms of response rate, EFS and OS of ARMM patients receiving S-BEAM.

    S-BEAM comprised standard BEAM (

    carmustine 300 mg/m2 on day 1,
    etoposide 200 mg/m2 days 1–4,
    cytarabine 400 mg/m2 days 1–4,
    melphalan 140 mg/m2 on day 5)
    with the addition of cisplatin (10-12.5mg/m2/d CI × 5d),
    bortezomib (1.3-1.5mg/m2 on days 1 + 4),
    thalidomide (100-200mg/d for 5 days) or lenalidomide (25-100mg/d for 5 days),
    DEX (40-100mg/d for 5 days) plus rapamycin (3mg d1, 1mg d2-5).

    Results The characteristics of 147 patients treated included prior transplant (Tx) in 67% (2Tx, 29%; =>3Tx, 11%), and prior exposure and resistance in virtually all patients (92%) to bortezomib, thalidomide, lenalidomide applied in VTD, VRD or with chemotherapy VTD-PACE.

    Reply
Marc Ardizzon says a couple of years ago

Hello again David,

Thank you for replying ASAP.
I read all your comments and links regarding Revlimid toxicity vs benefits and archived all your videos since my MM diagnosis stage 2 in may 2018.

I find all comments understandable and judicious.
As you imagine, I already know quite a bit about the « official » benefits and side effects of being on LDRMT.
It is nevertheless conforting to have an other perspective of someone who can talk about MM thru his own « 25 years off » experience.

Osteoporosis led to 3 compression vertebral fractures.and lower back arthrosis for wich my oncologist prescribed a once a month IV session to fortify my bones.

Concerning Revlimid side effects, I had a minor rash and some short lived fatigue episodes in the first months of Revlimid intake.
For the past months although, diarrhea is my main concern since it can happen without minimum notice day or night.

I told my oncologist and he was almost convinced that Revlimid is the culprit since it prevents the proper assimilation of bile acid thru my intestines.
He prescribed some anti cholesterol tablets for me to take everyday (2 grams of Colestid) away from my other medication, Colestid should prevent malabsorption of the bile and help alleviate diarrhea episodes.

Although reluctant to take some more medication, I am seriously considering starting taking Colestid soon as the episodes of diarrhea are to frequent and bothersome as you can imagine.

As you expressed in your latest video, there is no obvious contradiction in healthy nutrition and supplementation on the contrary according to latest studies on the subject linked on your blogue…simple and logical conclusion anyway.

Thank you for your well documented blogues and videos.
Your support and experienced input are appreciated.

Regards.
Marc

Reply
    David Emerson says a couple of years ago

    Hi Marc- It looks as though you are managing your MM as well as can be expected. Thanks for the kind comments. Good luck and hang in there,

    David

    Reply
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