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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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Multiple Myeloma Diagnosis t(4:14) No ASCT-

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Thus, it seems that Velcade (bortezomib) is able to significantly overcome the poor prognosis of  t(4;14) …Curcumin and bortezomib could exert synergistic effects on Multiple Myeloma cells, inhibiting cell proliferation and enhancing cellular apoptosis…”
Hi David, I received a multiple myeloma diagnosis (mm dx) in Dec 2018 two months after breast cancer.  Spent several months last year having treatment for the breast cancer. I have recently found out that I have the t(4:14) which put me high risk. I am currently receiving Velcade but do not want a stem cell transplant.  
I take lots of nutritional supplements and have changed my diet as well as off label drugs but wonder if you have any views on this high risk myeloma. Patty

HI Patty-
There is a lot going on in replying to your question. While I admit that I cannot address your situation completely, the information linked and excerpted below is meant to point you in the right direction to manage your multiple myeloma diagnosis.
Because of the complicated nature of your MM diagnosis, please consider talking to a MM specialist. I say this because I think you will want to manage your MM with as little chemo as possible. James Berenson MD specializes both in MM as well as low-dose MM dx management. Is actually anti- ASCT.
A bit of research this am points to Velcade (bortezomib) being effective against your type of MM 4:14 translocation while at the same time, curcumin enhances Velcade and according to the article below, is somewhat effective as MM therapy by itself. And it is cytotoxic to breast cancer as well.
Let me know if you have any questions about anything below.
Hang in there.
David Emerson
  • MM Survivor
  • MM Coach
  • Director PeopleBeatingCancer

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Anticancer effect of curcumin on breast cancer and stem cells

“Numerous studies have shown that curcumin, a natural compound, exerts anticancer effects by inhibiting cancer cell proliferation and metastasis and by inducing cell cycle arrest and apoptosis.

In particular, curcumin exhibits potent inhibitory effects on breast cancer, the most prevalent type of cancer among women worldwide. It has low maximal inhibitory concentration for breast cancer cell lines that express the hormone receptor ER and sensitizes cell lines to anticancer drugs.

Moreover, it can induce apoptosis in cell lines independently of hormone receptor expression. In addition, curcumin inhibits the proliferation of breast cancer stem cells (BCSC), an important factor that influences cancer recurrence…”

Curcumin induces cell death of the main molecular myeloma subtypes, particularly the poor prognosis subgroups.

“In the present study, a large panel of human myeloma cell lines (HMCLs) (n = 29), representing the main molecular MM subgroups, was screened for curcumin sensitivity. We observed that curcumin cell death induction was heterogeneous, of note
  • 16 HMCLs were highly sensitive to curcumin (LD50 < 20.5 μM),
  • 6 HMCLs exhibited intermediate LD50 values (20.5 μM ≤ LD50 < 32.2 μM)
  • and only 7 HMCLs were weakly sensitive (35 < LD50 < 56 μM).
Cell lines harboring the t(11;14) translocation were less sensitive (median LD50 32.9 μM) than non-t(11;14) (median LD50 17.9 μM), which included poor prognosis t(4:14) and t(14;16) cells. 

Synergistic effects of curcumin and bortezomib on multiple myeloma cells

“When the cells were treated with curcumin and bortezomib combination, the cell proliferation was further significantly declined, and the apoptosis was further enhanced, compared with the curcumin treatment alone at corresponding concentrations.

When these cells were treated with the curcumin and bortezomib combination, the activation of caspase-3 and -9 was further enhanced, while the expression levels of NF-κB and HSP-90 were further decreased.

Curcumin and bortezomib could exert synergistic effects on MM1.R cells, inhibiting cell prolifera- tion and enhancing cellular apoptosis, which involves the regulation of the expression levels of NF-κB and HSP-90 in these cells.

Use of bortezomib to overcome the poor prognosis of t(4:14), but not del(17p), in young patients with newly diagnosed multiple myeloma.

“A translocation t(4:14) was observed in 106 of these 507 patients treated with VD, whereas del(17p) was found in 60 patients.

Of note, 10 patients presented both the t(4;14) and the del(17p). The median PFS was 28 and 35 months, in patients with or without the t(4;14), respectively (p<0.02). At 3 years, 73% of the patients with t(4;14) were still alive, as compared to 89% of the patients lacking the translocation (p=0.002).

For comparison, the OS results were respectively 48% (patients with t(4;14)) and 73% (patients lacking the translocation) in patients treated with a VAD induction within the same period.

Thus, it seems that VD is able to significantly overcome the poor prognosis of t(4;14).

We also looked at the prognostic value of del(17p) in this series of patients treated with VD. In contrast to the t(4;14) situation, VD was enable to rescue patients with del(17p) (same PFS and OS for patients treated with VD than for those treated with a VAD induction).

Conclusions: Thus, this study (by far the largest so far reported) shows that VD as induction before intensification is able to improve the prognosis of patients with t(4:14), but not of those with del(17p).

#AskDrDurie: What are some treatment options for the t(4;14) abnormality?

In this episode of #AskDrDurie, IMF Chairman Dr. Brian Durie discusses treatment options available for those myeloma patients with the t(4;14) abnormality, including IMiDs, next-generation proteasome inhibitors, novel combination therapies, and autologous stem cell transplants.

DR. DURIE: This week’s #AskDrDurie question is from a patient who has the translocation 4;14 abnormality.

So this means that when the bone marrow was done, most likely at the time of diagnosis, FISH testing showed a problem with chromosome four and 14, with a switching of these two types of chromosomes.

This is a type of abnormality that is called an intermediate risk, so this means that many treatments will work well in this situation, but oftentimes the length of the remission of the response is shorter than average. And so, this particular patient asks,

‘What treatment should I use now? I had a very excellent response with Velcade upfront, but now the myeloma has relapsed, and so what are the additional options and therapy that could be considered?…”

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