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Multiple Myeloma Stem Cell Transplant Risk Bone Damage

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Bone Marrow Transplant Survivors Risk Long-term Collateral Damage to Bone, Heart, Nerve, Brain-

And those are just the multiple myeloma stem cell transplant side effects that I live with…

The main problem highlighted in the article linked and excerpted below is that multiple myeloma is a bone disease almost as much as it is a blood cancer.

Meaning, according to research, 80-90% of MM survivors will confront bone damage at some point during their MM experience.

People who are diagnosed with multiple myeloma are told that while myeloma is incurable it is treatable. This means that while MMers relapse and eventually succumb to this cancer, there are many chemotherapies  that have the ability to kill myeloma cells.

The trick then, is to figure out which chemotherapy, singly or in combination, high-dose, low-dose, etc. will result in the greatest overall survival. This is oncology speak for length of life.

Starting in the ’90’s (I was diagnosed in ’94) the autologus stem cell transplant (ASCT) became the go-to therapy for MMers. The ASCT is aggressive, high-dose chemotherapy. There are no two ways about it. A hematopoietic stem-cell transplant can mean a host of short, long-term and late stage collateral damage.

While many MMers do experience long remissions after an ASCT, many do not. I relapsed after my ASCT in ’95 after 10 months.

Along with overall survival (OS), MMers must think about quality of life after an ASCT. The study linked and excerpted below talks about bone loss and bone fracture as late effects of HSCT.

Fortunately, there are a number of therapies, both conventional and non-conventional, that are evidence-based bone strengthening therapies such as bisphosphate therapy, vitamin D, calcium, and others.

I am both a long-term Cancer Survivor and Cancer Coach. For more information about evidence-based, non-toxic bone therapies in addition to other evidence-based but non-toxic cancer therapies, scroll down the page, post a question or a comment and I will reply ASAP.

thank you,

David Emerson

  • Long-term MM survivor
  • MM Cancer Coach
  • Director Galen Foundation

Recommended Reading:

Increased Incidence of Fractures in Recipients of Hematopoietic Stem-Cell Transplantation

“The number of long-term survivors after hematopoietic stem-cell transplantation (HSCT) for malignant and nonmalignant disorders is increasing, and late effects are gaining importance. Osteoporosis and fractures can worsen the quality of life of HSCT survivors, but the burden of the disease is unknown…

A total of 7,620 patients underwent an HSCT from 1997 to 2011 at the MD Anderson Cancer Center of whom 602 (8%) developed a fracture. Age, underlying disease, and HSCT type were significantly associated with fracture. Age- and sex-specific fracture incidence rates after HSCT were significantly greater than those of the US general population in almost all subgroups. The striking difference was an approximately eight times greater risk in females and approximately seven to nine times greater risk in males age 45 to 64 years old when compared with the National Health Interview Survey and National Hospital Discharge Survey fracture rates.

Conclusion The incidence of fractures is compellingly higher after HSCT.”

Osteoporosis management in hematologic stem cell transplant recipients: Executive summary


•Bone health is an important long-term comorbidity post-HSCT.

•HSCT patients are at high risk of bone loss and fragility fracture.

•HSCT patients are at high risk of bone loss and fragility fracture.

•Recommendations are provided for better monitoring of bone health.

•Recommendations include bone assessment, dietary advice and osteoporosis medication.

Bone fragility and fracture are at the forefront for long-term morbidities post-HSCT.

Results-In HSCT recipients, evidence has accumulated to support recommendations for more extensive monitoring of bone fragility and more appropriate administration of osteoporosis pharmacotherapies for patients at high risk of bone loss and/or fracture.

Conclusion-This executive summary reports and summarizes the main recommendations published previously, including bone assessment, dietary and lifestyle recommendations and osteoporosis medication…

All patients receiving prolonged courses of glucocorticoid for GVHD are at high risk for bone loss and fracture. Therefore, prophylaxis with bisphosphonates, ideally zoledronic acid 5 mg, may be considered regardless of the T-score.

The major fractures due to osteoporosis are those of the hip, spine, wrist and proximal humerus and are associated with low BMD and other factors such as the tendency of falling, age, gender and race. They are called fragility fractures because they are occurring after a low-energy trauma, such as a fall from standing height. The risk of re-fracture is highest in the first two years following a first fracture [17], and thus a prior fragility fracture is a strong indication to treatment and should be initiated as soon as possible after fracture surgery, as secondary fracture prevention.

In younger women with treatment induced amenorrhea post-HSCT, estrogen-based Menopausal Hormone Therapy (MHT) may be an effective antiresorptive therapy and perhaps show additive benefits with regard to cardiovascular disease [18], although its efficacy in preventing glucocorticoid induced bone loss in this population has not been established [19], [20]…”

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