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Multiple Myeloma Stage 1- Bone Health?

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Do you know if you rib is a single bone plasmacytoma and not full MM? I ask only because a SBP is pre-MM like MGUS and SMM. I will link a post about SBP below.

Hello David.  I am a otherwise healthy 57 year old newly diagnosed with Multiple Myeloma Stage 1. I have 1 lytic lesion in rib. Just completed 1 cycle of Revlimid Velcade Dexamethasone (RVd).

In your blog post about bone health, you mentioned that denosumab is superior to biophosphates.  I have been prescribed Zometa infusion 1x/month.

Could you expand on the differences in the 2 classes of drugs.  I am a pesonal trainer and do exercise daily.  I do take D3, Magnesium and K.  Could you also share what dose of K you take?

Thank you for the wealth of information you share.  It is invaluable and much appreciated. Margaret

Hi Margaret-
I am sorry to read of your Multiple Myeloma stage 1 diagnosis. Keep in mind however, that you are young as MM patients go and a stage 1 (early) diagnosis of MM puts your prognosis ahead of 96% of the other newly diagnosed MM patients.
Do you know if you rib is a single bone plasmacytoma and not full MM? I ask only because a SBP is pre-MM like MGUS and SMM. I will link a post about SBP below.
Several things. To answer your question, denosumab is superior to bisphophonates (zometa, aredia, etc.) if you have kidney involvement. Denosumab is not excreted through your kidneys. Therefore there is no chance that it can interfere with your kidney function. If your kidney function is normal then you have little to worry about.
Because of your early stage MM diagnosis, you probably have pretty good diagnostic numbers. Studies confirm that early MM responds well to induction therapy. If you do respond well after only one or two cycles of RVd, (m-spike comes down, immunoglobulins/freelight chains return to normal, etc.), give serious consideration to discontinuing RVd therapy.
I say this because the FDA approved “standard-of-care” therapy plan for newly diagnosed Multiple Myeloma stage 1 patients- 4-6 rounds of RVd, ASCT, maintenance therapy, is much too much therapy (toxicity) for the stage 1 NDMM patient in my experience. I will link the “Cure vs. Control Debate in MM” below.
Also, studies confirm that there is no overall survival (length of life) benefit of an autologous stem cell transplant. Yes, longer first remission aka progression-free survival. But I’m guessing that your priority is length of life rather than a longer first remission. The average MM patient is 70 year of age. You are probably thinking more long-term.
Regarding you supplementation and lifestyle. Again, this fact, in addition to your age and early MM diagnosis, puts you in a fundamentally different position than the average NDMM patient.
Both your early MM stage as well as your lifestyle and supplementation should enhance your response to induction. It’s called “pre-habilitation.”
Depending on your serum calcium, you may not need either Zometa or denosumab. Local radiation could manage your lesion while bone health supplements such as vitamin D3, Mag. and K2 enhance your bone mineral density. Your bone health may already be above-average.
Or at the very least you could undergo just a 3-6 months of Zometa. Research shows that the majority of bone health benefit imparted by bisphophonates occurs in the first six months of administration.
I got a little carried away here. Sorry for the long reply.
Let me know if you have any questions.
Good luck,
David Emerson
  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Treatment of Myeloma: Cure vs Control

Although not often openly acknowledged, “cure vs control” is the dominant philosophical difference behind many of the strategies, trials, and debates related to the management of myeloma. Should we treat patients with myeloma with multidrug, multitransplant combinations with the goal of potentially curing a subset of patients, recognizing that the risk of adverse events and effect on quality of life will be substantial? Or should we address myeloma as a chronic incurable condition with the goal of disease control, using the least toxic regimens, emphasizing a balance between efficacy and quality of life, and reserving more aggressive therapy for later?…”

Plasmacytoma vs. Multiple Myeloma 

“A diagnosis of a single plasmacytoma of bone (SPB), smoldering multiple myeloma (SMM) or monoclonal gammopathy of undetermined significance (MGUS) are all diagnostic terms of “PRE-Multiple Myeloma.” That is to say, a diagnosis of any of these is not cancer but a diagnosis of a blood disorder.  While these diagnoses may increase the risk of and/or lead to full-blown multiple myeloma, an incurable blood cancer, they are NOT cancer…”

Denosumab compared with zoledronic acid on PFS in multiple myeloma: exploratory results of an international phase 3 study

“An exploratory end point from a recent trial in patients with newly diagnosed multiple myeloma showed that median progression-free survival (PFS) was increased by 10.7 months with denosumab vs zoledronic acid. We performed additional analyses to identify factors that may have contributed to the favorable PFS with denosumab.

Ad hoc analyses were performed for patients intending to undergo autologous stem cell transplantation (ASCT; ASCT intent), not intending to undergo ASCT (ASCT no intent), and intent-to-treat according to age (<70 or ≥70 years) and baseline renal function (≤60 mL/min or >60 mL/min creatinine clearance [CrCl]). Of 1718 patients, 930 (54.1%) were in the ASCT-intent subgroup, and 788 (45.9%) were in the ASCT-no-intent subgroup…

In the ASCT-no-intent subgroup, no benefit with denosumab vs zoledronic acid was observed. PFS favored denosumab vs zoledronic acid in patients with CrCl >60 mL/min and in patients <70 years old, but no difference was observed in patients with CrCl ≤60 mL/min or patients ≥70 years old.

The PFS difference observed with denosumab is one of the notable benefits reported in newly diagnosed multiple myeloma and was most pronounced in patients intending to undergo ASCT and those who received proteasome inhibitor (PI)−based triplet regimens…”

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