Multiple Myeloma Patients are ALL “Toxicity-Vulnerable”

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Are you a “Toxicity-Vulnerable” Multiple Myeloma Patient? “This prospective multicenter study demonstrated that chemotherapy toxicity is common in older adults, with 53% experiencing at least one grade 3 to 5 toxicity.”

It isn’t just old people who are “vulnerable to chemotherapy toxicity.Everyone suffers collateral damage when they undergo chemotherapy. I’m not just talking about the short-term side effects that people associate with chemotherapy such as hair loss and nausea. I’m talking about heart, brain and nerve damage. Common side effects that the majority of multiple myeloma patients suffer from.

I know. I was first diagnosed with multiple myeloma when I was 36 back in 1994. I was strong and otherwise healthy. Yet the chemotherapy regimens I underwent during ’95-’96 left me with short, long-term and late stage side effects. Some of these side effects healed. Some didn’t. Some side effects got worse over time.

Practically speaking, MMers must think long-term. Studies show that achieving complete or very-good partial remission is not required for a long overall survival. Meaning your induction therapy is probably going to be the first chemo regimen of several over the next decade or two.

There is a solution. Evidence-based Integrative therapies to enhance the efficacy of your chemo. Evidence-based, anti-MM nutrition, supplementation and lifestyle therapies.

The article linked and excerpted below talks about a chemo regimen for newly diagnosed MMers called VCD-Lite that is effective but should be used only for older folks who are too frail to withstand higher doses of chemotherapy.

Multiple Myeloma at a glance. Click the image below-

Multiple Myeloma Mind Map

The solution is not rocket science. I’m not talking about some sort of “ancient Chinese secret.” The induction chemotherapy “VCD-Lite” discussed below combined with the Multiple Myeloma Cancer Coaching Program will mean effective MM management with a LOT LESS toxicity.

Have you been diagnosed with MM? What symptoms are you experiencing? Scroll down the page, post a question or a comment and I will reply to you ASAP. Click the link on the right side of the page to watch the free webinar about the MM CC Program.

Thank you,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Predicting Chemotherapy Toxicity in Older Adults With Cancer: A Prospective Multicenter Study

“Older adults are vulnerable to chemotherapy toxicity; however, there are limited data to identify those at risk. The goals of this study are to identify risk factors for chemotherapy toxicity in older adults and develop a risk stratification schema for chemotherapy toxicity...

Chemotherapy Toxicity

At least one grade 3 to 5 toxicity occurred in 53% of patients (39% grade 3, 12% grade 4, and 2% grade 5 [percentages reflect the worst grade of toxicity experienced]; Table 3). Grade 3 to 5 hematologic and nonhematologic toxicity occurred in 26% and 43%, respectively. The most common grade 3 to 5 hematologic toxicities were neutropenia (11%), leucopenia (10%), and anemia (10%). The most common grade 3 to 5 nonhematologic toxicities were fatigue (16%), infection (10%), and dehydration (9%). Thirty-one percent of patients required a dose reduction during therapy, 31% had a dose delay, and 23% were hospitalized during treatment…


This prospective multicenter study demonstrated that chemotherapy toxicity is common in older adults, with 53% experiencing at least one grade 3 to 5 toxicity. Among these, 2% experienced a treatment-related mortality. A predictive model was developed to identify those patients at greatest risk, including factors obtained in everyday practice (patient age, number of chemotherapy drugs, dosing, and laboratory values) and factors not typically used in everyday oncology practice (geriatric assessment variables). This model had a greater ability to discriminate risk of chemotherapy toxicity than the KPS, which is commonly used in oncology practice.

Older adults are at increased risk for chemotherapy toxicity; however, oncologists are left with little guidance when it comes to identifying risk factors other than chronologic age.

It is generally recognized that chronologic age does not equate to physiologic age. Geriatricians perform a geriatric assessment to identify clinical predictors of morbidity and mortality; however, this assessment has not been routinely incorporated into oncology care because of the time and resource requirements. Furthermore, there is a lack of guidelines regarding how to interpret the findings in the context of oncology care…”

‘VCD-Lite’ Viable Option for Older, Toxicity-Vulnerable Myeloma Patients

“Dose-attenuated bortezomib, cyclophosphamide, and dexamethasone (VCD-lite) is a viable treatment option for vulnerable or frail adults with newly diagnosed multiple myeloma…

“With the high and increasing proportion of patients with multiple myeloma being very old and/or otherwise vulnerable to chemotherapy toxicity, it is increasingly important to determine the best regimens for treating these patients, yet existing clinical studies largely miss that mark by focusing on younger, fitter patients,”

“The best regimens maximize the likelihood of multiple myeloma control, ie, efficacy, while minimizing risk of severe toxicity…

Meanwhile, regarding current clinical practice we recognize recent studies that have shown that induction regimens that incorporate both proteasome inhibitors and immunomodulatory agents are likely the emerging standard of care for newly diagnosed myeloma,” the researchers wrote. “As a result, off protocol we frequently employ the dose-reduced lenalidomide, bortezomib, dexamethasone (‘RVD-lite’) for patients willing to come for once weekly bortezomib.””



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