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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Remission… what does this mean? Should you attempt to reach minimal residual disease (MDR) when you consider induction therapy for your multiple myeloma (MM)? Your oncologist will push for the deepest possible remission. Should you undergo aggressive toxicity from your induction chemo regimens in hopes of reaching MRD? That depends on several things.
I will begin by saying that all MM patients want to achieve complete remission aka no detectible MM in their blood. Let’s be honest… we want MM gone… At the same time, we want to achieve the longest OS aka overall survival and we want to achieve the highest quality-of-life.
The challenge faced by all newly diagnosed MM patients is that you have to walk a fine line between the damage done to your body by your multiple myeloma and the damage done to your body from chemotherapy and radiation. And there is no guarantee that aggressive chemo means a deep response and no guarantee a deep response is a long remission.
The two most important sentences in the articles linked and excerpted below are:
That means that you can reach a state of almost no MM anywhere in your system and still not achieve long-term survival. Conversely you can not reach complete remission post induction therapy and still achieve long-term survival. The meaning of the confusingly-worded second sentence means despite lots of new FDA approved MM drugs, average 5 years survival rate is still about 50%.
And you know what the most revealing statistic is about MM therapy? The MM specialist with the best/longest average five and te year patient survival rate, Dr. James Berenson, doesn’t even prescribe an autologous stem cell transplantation. Much of MM decision-making is based on experience and judgement.
I am a long-term MM survivor and MM cancer coach. Research and experience has taught me that MMers must use the best of both conventional and evidence-based non-conventional therapies to beat myeloma.
“Achieving minimal residual disease-negative status surpasses the prognostic value of complete remission and should be considered a relevant endpoint for transplant-eligible and fit elderly patients with multiple myeloma…
Further, the clinical utility of complete remission has been questioned, because rates do not always predict outcomes, and some patients without complete remission may still achieve long-term survival…
“Minimal residual disease is a promising biomarker for guiding the management of multiple myeloma that is becoming increasingly important with the advent of more efficacious therapies, according to emerging data and expert opinion…
“The story of minimal residual disease in multiple myeloma is like a revolution…”
“Multiple Myeloma Remission and Relapse –
What does it mean to be in remission with multiple myeloma? Let’s first talk about the basics: being in remission with myeloma is not the same as being cured of myeloma. Remission can be in part or in full. You may still have detectable myeloma but have fewer cancer cells present. Every patient wonders how long that remission will last, but there is no simple formula and every patient is different. It can depend on the type of myeloma treatment you receive, the genetics of your myeloma and other health factors.
It is common for myeloma to return after an initial remission. This is called relapsed multiple myeloma. The goal of today’s treatment is to extend the length and depth of remissions until a cure can be found.
There are various levels of response patients can have to treatment:
Stable Disease (SD)
Stable Disease is when a patient has had some response to treatment but less than 50% reduction in monoclonal protein levels. Their disease is not improving or getting worse.
Partial Response (PR)
Partial Response is when a patient has had over a 50% reduction in their blood monoclonal protein and a reduction of M-protein in the urine of over 90%. If a patient had a plasmacytoma (a single lesion), a partial response would mean over a 50% reduction in tumor size.
Very Good Partial Response (VGPR)
A Very Good Partial Response means that the monoclonal protein levels can be detected by the IFE (immunofixation test), but not by the electrophoresis test in the blood and urine. It also means that the M-protein has been reduced in the blood by over 90%.
A Complete Response means that there is no detectable monoclonal protein in the body.
Stringent Complete Response
Stringent Complete Response means that a patient has achieved a Complete Response and they also have a normal free light chain ratio and have no clonal cells in the bone marrow as measured by immunohistochemistry or immunoflourescence.
Minimal Residual Disease Negative
More sensitive testing is available that can detect lower levels of disease either by flow cytometry or by Next Generation Sequencing testing. If a patient is MRD negative, it means they have achieved a Stringent Complete Response and no myeloma cells can be detected in a sample of a million. This is a bone marrow biopsy test.