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Multiple Myeloma- Surgery after Chemotherapy?

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Dr. Durie stresses the importance that MM survivors lead as “normal” a life as possible and that surgery in this case, can help this. I agree.

David, do you know anything about the safety of knee surgery for multiple myeloma (MM) patients? I am thinking I need it but afraid of infections, slow healing, blood transfusions, spreading cancer out of the bone when they cut, if bones can withstand this if compromised with lesions, etc.
For background:
  • I’m not on any blood thinners.
  • I’m holding steady on blood counts.
  • I’m take Darzalex and dexamethasone once per month.
  • My kidneys and liver slightly affected but not on any meds for it.
  • Taking alcyclovir and the valtrex to way lay getting shingles and pneumonia.

Your insight would be helpful.

Thanks.  Mary Jo

Hi Mary Jo-

Thanks for your reply. Several things. I will link a short video of Dr. Brian Durie on this issue. I am always happy when my thinking on an issue like this corresponds with the thinking of a MM specialist like Dr. Durie. In short, we both say go ahead with the surgery but be aware of several issues.
Also, below the link to Dr. Durie’s comments I link an exchange about this issue from The Myeloma Beacon. I think the doctor makes several excellent points. The issue that Imids, Revlimid and Thalidomide, have a greater risk of DVT/blood clot is important.
  1. Make sure your MM is under control- you said your MM is-
  2. Make sure your white blood cells are okay- accordingly you are “holding steady”
  3. Dr. Durie cautions patients not to be on blood thinners- which you say you are not
  4. Dr. Durie says to be 7-10 days from any previous chemo- any you tell me that you have Darzelex and Dex. once a month so this is okay-
And lastly, you mention “kidney and liver slightly affected.” I’m not sure what to make of this so I will fall back on Dr. Durie’s suggestion for your oncologist to talk to the surgeon who will handle your surgery.
Oh, almost forgot. You mention that you are on prophylactic alcyclovir and the valtrex- This is a good thing, I believe, because Dr. Durie mentions taking antibiotic before the patient’s surgery, also as a preventative. It seems to me that you will kill two birds with one stone in this case. Not a great analogy…sorry.
Dr. Durie stresses the importance that MM survivors lead as “normal” a life as possible and that surgery in this case, can help this. I agree.
Let me know if you have any questions.
David Emerson
  • MM Survivor
  • MM Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Ask Dr. Durie: I Need to Have Surgery: Can I Do That?

“Dr. Brian G.M. Durie is the Chairman of the Board of Directors of the International Myeloma Foundation. He began studying multiple myeloma over 30 years ago, and is recognized around the world as one of the top myeloma doctors.”

Multiple myeloma and knee replacement

“1) Patients with myeloma on IMiDs (Revlimid or thalidomide) are at higher risk of blood clots (DVTs, PEs), and hence when undergoing joint replacement, it is recommended to move from aspirin prophylaxis straight up to full dose anticoagulation (coumadin with a target INR 2-3 or therapeutic doses of lovenox or equivalent)

2) Patients with low white cell counts, hemoglobin (anemic), or platelets (thrombocytopenic) are in general higher risk for surgery. Hence it would be ideal if the patient could tolerate at least a 1-2 month chemotherapy holiday.

3) You’ll want to know more than just if her counts are acceptable. You really need to know that her affected immmunoglobulin or free light chain is getting better. If her counts are normal but the antibody her myeloma cells are producing (aka the affected immunoglobulin) is rising, this is NOT the time to do elective surgery…”


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