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Multiple Myeloma Side Effects- Diarrhea, Fatigue-

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“Nonetheless, with the advent of present novel therapies, specialists have challenged the notion that HDT/ASCT should be administered early after diagnosis.”

Hi David- I will be finishing chemo in four weeks, then stem cell transplant. I have experience side effects of extreme exhaustion and diarrhea followed by constipation. Can I expect to. Side effects improve? Thanks, Carli-

HI Carli-
I am sorry to read of your side effects. Regarding if your side effects will improve, I will reply to each one that you mentioned to reply as fully as I can.
Extreme exhaustion– fatigue in your case is the kind of tired that doesn’t go away after a good nights sleep. Fatigue is often a result of anemia. Anemia is a result of reduced red blood cells in your blood. MM itself can cause this form of myelosuppression, and chemotherapy can also cause anemia making this type of extreme fatigue both a symptoms and a side effect.
Chances are your chemotherapy will reduce your MM, meaning that this symptom will go away. Unfortunately, it will take anemia caused by chemotherapy awhile to heal.
Diarrhea followed by constipation- while CIC and CID are common side effects of chemotherapy, according to the article below, no one knows why these side effects occur much less know how to manage them. I was told to eat bananas- this fruit reportedly helped both CIC and CID.
Regarding your planned autologous stem cell transplant, you can expect these side effects to continue or to even worsen. ASCT is a procedure that incorporates aggressive, high-dose chemotherapy followed by a stem cell “rescue.” Meaning, your doctor gives you a new immune system to replace the one that got wiped out by the high-dose chemotherapy.
Carli, something to consider-
According to the last study linked and excerpted below, there is no difference in OS (overall survival aka length of life) if MM patients have an ASCT early or late. If your induction chemotherapy, the chemo you’ve been doing, has stabilized your MM, please consider taking a therapy vacation.
By this I mean that your body clearly is negatively affected by chemotherapy. Giving your body time off may give you time to heal, may give you time to feel normal again. If you relapse, you can always undergo an ASCT, but later after you’ve healed.
Do you know your stage at diagnosis?
Are you experiencing any other side effects- nerve damage?
Let me know if you have any questions.
Hang in there, Carli.
David Emerson
  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading-

Chemotherapy-Induced Constipation and Diarrhea: Pathophysiology, Current and Emerging Treatments

“Gastrointestinal (GI) side-effects of chemotherapy are a debilitating and often overlooked clinical hurdle in cancer management. Chemotherapy-induced constipation (CIC) and Diarrhea (CID) present a constant challenge in the efficient and tolerable treatment of cancer and are amongst the primary contributors to dose reductions, delays and cessation of treatment. Although prevalence of CIC is hard to estimate, it is believed to affect approximately 16% of cancer patients, whilst incidence of CID has been estimated to be as high as 80%.
Despite this, the underlying mechanisms of both CID and CIC remain unclear, but are believed to result from a combination of intersecting mechanisms including inflammation, secretory dysfunctions, GI dysmotility and alterations in GI innervation. Current treatments for CIC and CID aim to reduce the severity of symptoms rather than combating the pathophysiological mechanisms of dysfunction, and often result in worsening of already chronic GI symptoms or trigger the onset of a plethora of other side-effects including respiratory depression, uneven heartbeat, seizures, and neurotoxicity

Persistent Fatigue in Hematopoietic Stem Cell Transplantation Survivors

“Background- Fatigue is highly prevalent following hematopoietic stem cell transplantation (HCT). It has been described as intense and may last for years following treatment…

Results-HCT survivors reported increased physical (p < .001), mental (p <.001), and overall fatigue (p < .001) as well as increased anxiety (p < .05) and depression (p < .01) compared to healthy controls. Red blood cell (RBC) levels were significantly lower in HCT survivors (p < .001). RBC levels for both groups, however, were in the normal range. TNF-α (p < .001) and IL-6 (p < .05) were significantly higher in HCT survivors.

Conclusions-  Persistent fatigue in HCT survivors compared to healthy controls with occasional tiredness is accompanied by increased anxiety and depression along with decreased RBCs. Elevated TNF-α and IL-6 may be important biomarkers.

Diarrhea after autologous stem cell transplantation in low-middle income countries: is Clostridium difficile the most prevalent infectious etiology?

“Diarrhea is a major cause of morbidity during high-dose chemotherapy followed by autologous stem cell transplantation (ASCT). It occurs in almost half of recipients of ASCT and generally, it is attributed to the effects of high-dose chemotherapy on the gastrointestinal mucosa and the effects of broad-spectrum antibiotic regimens for the prophylaxis and treatment of neutropenia. However, other etiologies might be considered, such as viral, bacterial and parasitic infections...
Despite being the most common etiology of diarrhea after ASCT, the conditioning regime is seldom implicated in severe complications, with some exceptions. Cytarabine-containing regimens, high-dose melphalan (≥200 mg/m2), and regimens containing multiple alkylating agents may cause more severe diarrhea.
“What is the value of early versus late ASCT?
Frontline HDT/ASCT has been the standard for treating newly diagnosed multiple myeloma in young, fit patients and select elderly patients. Nonetheless, with the advent of present novel therapies, specialists have challenged the notion that HDT/ASCT should be administered early after diagnosis.
In 1998 before the era of novel agents, Fermand et al.studied the effect of autologous transplantation timing (early versus late) on OS. Patients who were randomized into the “early” arm received HDT/ASCT right away and those in the “late” arm received conventional chemotherapy until progression or relapse whereby they were supported with HDT/ASCT as well. There was no difference in OS between the two groups…”

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