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MDR, End-Stage Multiple Myeloma- Any Suggestions?

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“The most commonly reported side effects included keratopathy, decreased visual acuity, nausea, blurred vision, pyrexia, infusion-related reactions and fatigue.”

Hi David- I am worried that my mom has reached end-stage Multiple Myeloma. My mom was diagnosed with MM 2 years ago. She underwent an autologous stem cell/bone marrow transplant, many different types of chemo, failed out of a CAR-T trial, and the latest was a brand new treatment called BLENREP.

She responded horribly to the BLENREP and the doctor suggested she stop treatment and gave her a few months. She is very weak and very sick. Is it too late to use the green tea and cucurmin for her? Any other suggestions?

 Hi Lisa-
I am sorry to read of your mom’s MM and possible end-stage MM. At this point in your mom’s MM treatment plan, the issue is mainly where she is, MM wise. In other words, how advanced is her MM? Is she dealing with any serious side effects? How is her health overall?
First and foremost, I agree with your oncologist’s recommendation to take some time to rest, heal, etc. After an autologous stem cell transplant, CAR-T cell and BlenRep, your mom has undergone a tremendous amount of toxicity. It is no wonder that she is sick and exhausted.
There is no question that curcumin, green tea (EGCG), resveratrol, omega-3 fatty acids, etc. are apoptotic (kill) to MM. Research has clearly established that.
The issue for you and your mom to consider is if non-toxic therapies can control your mom’s MM at this point?
Let me state your mom’s case as I see it. 
After living with MM for the past two or so years, your mom has undergone 
  • a bone marrow transplant, 
  • many different types of chemo
  • CAR-T Cell therapy
all of which may have worked, more or less, to kill your mom’s MM but have taken a toll on your mom’s health. This is the norm for most people. Some experience longer remissions but every MM survivor ends up with “multi-drug resistance.” Please see the study linked below. Meaning their MM becomes refractory to all chemotherapy regimens. 
My suggestion would be for your mom to undergo one or more integrative therapies. This means, for example, low-dose velcade (Bortezomib) combined with non-toxic supplements shown to enhance velcade. Velcade is a protease inhibitor. I will link a post below that explains how many supplements such as curcumin, resveratrol, etc. enhance the effect of proteasome inhibitors. 
You mentioned that your mom is “very weak and very sick.” She may be feeling this way because of all the chemotherapy aka toxicity she had gone through over the past two years. One of the main side effects of chemotherapy is myelosuppression- anemia, neutropenia, and/or thrombocytopenia. Lowering white blood cells make cause your mom to be susceptible to colds, flu, etc. 
There are a host of non-toxic therapies- nutrition and supplementation, that can help your mom heal aka get her strength back. 
Do you have your mom’s most recent blood work? Do you know her:
  • red blood cell,
  • white blood cell,
  • platelet counts? 
Do you know your mom’s freelight chain levels (kappa, lambda, ratio)?
Do you know her m-spike aka monoclonal protein levels?
I encourage your mom to eat as nutritiously as possible while adding anti-angiogenic nutrition and supplementation to her diet. 
Let me know if you have any questions Lexi. If you can provide information re the questions I ‘ve asked I can provide more info for you and your mom. 
David Emerson
MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer

Recommended Reading:

Drug resistance in multiple myeloma

However, most patients eventually relapse and often demonstrate multiple drug resistance. Therefore there is still an urgent and unmet need to define the molecular mechanisms of resistance for available drugs in order to enhance the use of existing treatments and design more effective therapies. Genetic abnormalities are well known to play a central role in MM resistance to available drugs, and epigenetic aberrations mainly affecting the patterns of DNA methylation and histone modifications of genes, especially tumor suppressors, can be involved in the resistance mechanism. Moreover, defects in the mechanisms of apoptosis, senescence and DNA repair could also contribute to drug resistance…

 Multiple Myeloma Chemotherapy- Proteasome Inhibitors

Bortezomib (velcade), Carfilzomib (kyprolis) and Ixazomib (ninlaro) are all proteasome inhibitors. All three chemotherapy drugs are multiple myeloma chemotherapy regimens approved by the FDA.

The challenge for multiple myeloma survivors however, is that each proteasome inhibitor will stop working eventually. MDR aka multi-drug resistance is a fact for all multiple myeloma chemotherapy regimens.

If you are a MM patient or survivor who has undergone several multiple myeloma chemotherapy regimens already and is wondering about your next therapy steps, consider integrative therapies- combinations of conventional and non-conventional proteasome inhibitors that integrate or enhance each other…”

FDA Approves Blenrep to Treat Relapsed/Refractory Multiple Myeloma

“The Food and Drug Administration approved Blenrep (belantamab mafodotin-blmf) to treat patients with relapsed/refractory multiple myeloma who have received 4 prior therapies…

The indication, which includes patients who have received 4 prior therapies including an anti-CD38 monoclonal antibody or a proteasome inhibitor and an immunomodulatory agent, is approved under accelerated approval based on a 31% response rate in the DREAMM-2 study.

In addition, the median duration of response had not been reached at the six-month analysis. Of the 73% of patients who responded to therapy, however, their duration of response was six months or longer.

The most commonly reported side effects included keratopathy, decreased visual acuity, nausea, blurred vision, pyrexia, infusion-related reactions and fatigue.

“While treatable, refractory multiple myeloma is a significant clinical challenge with poor outcomes for patients whose disease has become resistant to the current standard of care…”

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