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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 Induction- RVD W/ or W/O ASCT?

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“…Demonstrates the ability of 3-drug (RVD)  induction regimens in patients with newly diagnosed multiple myeloma to result in a substantial survival benefit.”

The standard-of-care therapy plan for newly diagnosed multiple myeloma (NDMM) patients includes induction therapy of RVD followed by an autologous stem cell transplant followed by maintenance therapy.

When it comes induction therapy for NDMM, there is no question that RVD (revlimid, velcade, dexamethasone) achieves superior overall response rates (ORR). According to the research linked below, just over 97% of NDMM responded to RVD.

Once RVD is established as the gold standard for the induction therapy that achieves the highest overall response rate, the two issues then, as I see it anyway, are

  1. According to the studies below, what is the impact of ASCT, post RVD induction,  to overall survival? OS is length of life. PFS is the length of remission. 
  2. What are the risks of adding an ASCT to induction therapy? What are the short, long-term and late stage side effects of an ASCT?

The answer to question number 1,  according to the second study linked below, is that ASCT adds nothing to the overall survival of NDMM patients who undergo both RVD as well as ASCT.

The answer to question number 2 is:

  • 1.4% INCREASE in overall response rate yet the risk of short, long-term and late stage side effects is dramatic-

Of the 1000 NDMM patients in the study, 971 responded to RVD induction therapy alone and another 14 NDMM patients responded with the addition of  ASCT.

Set aside the fact that an ASCT costs tens of thousands of dollars and possibly weeks away from work and family. If you have good health insurance you probably only have to pay a fraction of that cost.

Considering the short, long-term and late stage side effects that result from an ASCT, it seems to me that 1.4% is a paltry number of NDMM who respond given 971 patients who undergo ASCT may experience-

  • endocrine disorders,
  • cognitive disfunction, 
  • musculoskeletal disorders,
  • subsequent malignancies,
  • cardiomyopathy,
  • congestive heart failure (CHF),
  • valvular dysfunction,
  • arrhythmia,
  • pericarditis

and more.

In other words, less than .14% of additional MM patients respond if they receive an ASCT. Yet all 1000 MM patients develop short, long-term and/or late stage side effects if they undergo an ASCT. If the study linked below is design to assess risk, then I think oncology is missing the real risk associated with an ASCT

There was no information included in the first study about patients who had RVD induction ONLY or patients who underwent RVD AND ASCT and how it affected progression-free survival and overall survival. I had to include another study (below) to study that question. 

Why then, would a MM patient want to risk all those short, long-term and late stage side effects with high-dose toxic chemotherapy???

Because induction therapy followed by an autologous stem cell transplant is the standard of care for newly diagnosed MM patients, your oncologist will probably promote this expensive, risky procedure. I think the safe thing for all NDMM patients is to undergo induction therapy and then harvest your stem cells. You can freeze your stem cells and decide later if you want to have an ASCT.

The diagnosis, management and survival of multiple myeloma is complicated. Conventional, non-conventional, integrative, complementary therapies- all require a great deal of knowledge and experience.

If you would like to learn more about long-term multiple myeloma survival, scroll down the page, post a question or comment and I will reply to you ASAP.

Hang in there,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Long-Term Follow-Up Results of Lenalidomide, Bortezomib, and Dexamethasone Induction Therapy and Risk-Adapted Maintenance Approach in Newly Diagnosed Multiple Myeloma

“We describe 1,000 consecutive patients with newly diagnosed myeloma treated with RVD induction therapy from January 2007 until August 2016…

The overall response rate was-

  • 97.1% after induction therapy and
  • 98.5% after transplantation…

The estimated median progression-free survival (PFS) time was-

  • 65 months  for the entire cohort,
  • 40.3 months for high-risk patients, and
  • 76.5 months for standard-risk patients.

The median overall survival (OS) time was-

  • 126.6 months for the entire cohort
  • 78.2 months for high-risk patients, and
  • it has not been reached yet for standard-risk patients

Five-year OS rates for high-risk and standard-risk patients were 57% and 81%, respectively, and the 10-year OS rates were 29% and 58%, respectively…

RVD is an induction regimen that delivers high response rates (VGPR or better) in close to 90% of patients after transplantation, and risk-adapted maintenance can deliver unprecedented long-term outcomes.

This study includes the largest cohort of patients treated with RVD reported to date with long follow-up and demonstrates the ability of 3-drug induction regimens in patients with newly diagnosed multiple myeloma to result in a substantial survival benefit.”

Lenalidomide, Bortezomib, and Dexamethasone with Transplantation for Myeloma.

“RESULTS: Median progression-free survival was significantly longer in the group that underwent transplantation than in the group that received RVD alone (50 months vs. 36 months; adjusted hazard ratio for disease progression or death, 0.65; P<0.001).

This benefit was observed across all patient subgroups, including those stratified according to International Staging System stage and cytogenetic risk.

The percentage of patients with a complete response was higher in the transplantation group than in the RVD-alone group (59% vs. 48%, P=0.03), as was the percentage of patients in whom minimal residual disease was not detected (79% vs. 65%, P<0.001).

Overall survival at 4 years did not differ significantly between the transplantation group and the RVD-alone group (81% and 82%, respectively).

  • The rate of grade 3 or 4 neutropenia was significantly higher in the transplantation group than in the RVD-alone group (92% vs. 47%),
  • as were the rates of grade 3 or 4 gastrointestinal disorders (28% vs. 7%) and
  • infections (20% vs. 9%).

No significant between-group differences were observed in the rates of treatment-related deaths, second primary cancers, thromboembolic events, and peripheral neuropathy.

CONCLUSIONS: Among adults with multiple myeloma, RVD therapy plus transplantation was associated with significantly longer progression-free survival than RVD therapy alone, but overall survival did not differ significantly between the two approaches.”


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