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Multiple Myeloma- Carfilzomib Cardiotoxicity, MRD Neg, DKRd Clinical Trial

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If your dad has reached MRD negative status post MM induction therapy, after undergoing only three cycles of DKRd, according to research his progression-free survival (PFS) and perhaps even his overall survival (OS) may be above average

Hi David- Thanks so much for all the great info. and taking the time to respond, it’s greatly appreciated. My dad’s  multiple myeloma (MM) was found by accident during a chest CT scan. A small tumor in upper rib cage, then a MRI scan showed 2 tiny lesions in his spine. No symptoms at all. My dad  went in a trial of Daratumamab, Revlimid,  Carfilzomib, and Dexamethasone (DKRd).

My dad  completed  3 treatments/cycles before he stopped the chemotherapy as it irritated his heart. Fortunately,  after just 3 cycles of DKRd, there was no trace in his blood or urine,and just a small amount in marrow sample.then he went on DRD therapy for 6 months.

My dad had  bone marrow biopsy taken yesterday at Sloan. Dr. Landgren  feels that my dad may be MRD negative now…fingers crossed.
I asked Dr Landgren if my Dad could take vitamin K2 and he said absolutely.  I also have my dad taking Astaxanthin.
As far as stage I guess 2. They said they don’t really stage multiple myeloma, so I’m not sure.
The revlimid made my dad feel crappy but treatment is over and he feels pretty good now.  He is going to do monthly maintenance with Daratumamab.
How much K2 should I have him take per day?
Thanks again Sam

Hi Sam-
Several things to consider. It may sound strange for me to say that your dad may have lucked out. Meaning, by diagnosing your dad’s MM by chance, it was discovered before any real damage could be done by his MM.
Also, early stage MM requires less toxicity to put into remission than advanced MM. Meaning, your dad is fortunate to have to undergo only 3 courses of induction therapy.
If your dad has reached MRD negative status post MM induction therapy, after undergoing only three cycles of DKRd, according to research,  his progression-free survival (PFS) and perhaps even his overall survival (OS) may be above average.
I recommend that your dad be tested to check his MRD status. The FDA recently approved this test and therefore is covered by Medicare and may be covered by his health insurance. Documenting his MRD status may influence his/Dr. L therapy plan going forward. Meaning your dad may not have to have an autologous stem cell transplant.
To put it differently, studies show that your dad might not have a longer EFS or OS if he has reached
Re your dad’s heart reacting negatively to carfilzomib. The cardiotoxicity of carfilzomib is well-established. I will link a blog post discussing the issue. Your challenges are:
  1. some of the documented heart damage is long-term or late stage damage and therefore doesn’t show up for months or years from now- and
  2. those therapies that have been studied are not FDA approved therefore Dr. Lundgren will not talk about them.
Re Vitamin K2 dosing. I take the dose recommended on the bottle. I take several different documented anti-MM supplements daily- curcumin, resveratrol, EGCG, others. Not high dose of any single antioxidant but several  different supplements. I believe that these anti-MM supplements keep me in complete remission. I believe they can also for your dad, especially if he is MRD negative- very little MM in his body.
I hope I covered everything. Let me know if you have any questions.
David Emerson
  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

A Phase II Study of Daratumumab in Patients with Newly Diagnosed Multiple Myeloma

“Full Title- Daratumumab, Carfilzomib, Lenalidomide, and Dexamethasone in Newly-Diagnosed Multiple Myeloma: A Clinical and Correlative Phase II Study

Purpose- The purpose of this study is to evaluate the safety and effectiveness of daratumumab in combination with carfilzomib, lenalidomide, and dexamethasone in patients newly diagnosed with multiple myeloma. Researchers will also assess the amount of myeloma cells remaining after treatment with daratumumab, a measure known as minimal residual disease (MRD).

The information that doctors learn from the MRD tests will also be used to determine the best amount of time that patients should be on treatment.

Lenalidomide and dexamethasone have already been FDA-approved as treatments for newly diagnosed myeloma patients. Daratumumab and carfilzomib are approved for patients whose myeloma came back after prior therapy. The use of these drugs in combination in newly diagnosed patients is considered investigational.

Daratumumab and carfilzomib are given intravenously (by vein), and lenalidomide and dexamethasone are taken orally (by mouth)…”

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