Multiple Myeloma Therapy- Low-dose Maintenance vs. Stem Cell Transplant?

“However, the rapidity of achievement of this response (VGPR or better), whether early or late during the course of the treatment, does not impact survival…”

Hi David- I am currently undergoing multiple myeloma therapy. My history is below. My oncologist is pushing an autologous stem cell transplant yet I seem to be doing fine with low-dose maintenance therapy. What to you think?

1. Diagnosed MM in : November 2017.
2. Treatment : Started in Dec2017.
The suggested treatment was 6 cycles of Chemotherapy and there after Bone Marrow Transplant (Autologous BMT). Each cycle of 28 days of chemotherapy includes Lenalidomide 25mg for 21 days and 7 days off (28 days), Bortezomib 2mg & Dexamethasone 40mg ,both, once in a week for 4 weeks (28 days)., and Zoldronic acid 4mg, once in a month. With the treatment of Steroid, Now I am diabetic.
3. After 6 Chemo cycles, the report was suggestive of CR.

It was planned to undergo Autologous Bone Marrow Transplantation (PBSCT), at RCC Thiruvavanthapuram. But delayed due to excess rush at RCC.
Hence, Bortezomib 2mg & Dexamethasone 40mg (both, once in a week) and Zoldronic acid 4mg, (once in a month) are continued …..
4. In Dec 2018, the report was suggestive of VGPR.
5. In April 2019, I was admitted for HDCT and PBSCT. GCSF was given for 5 days. Two sessions of aphaeresis were also done with stem cell yield of 3.8×106/ kg. But bleeding was started from catheter sites. The HDCT and PBSCT were abandoned. Further investigation was suggestive of Factor-VIII and vWF deficiency (mild disorder). I have never faced such bleeding disorder till then. No such cases were reported in my family also.
6. After that, Bortezomib 2mg & Dexamethasone 40mg (both, once in a week) and Zoldronic acid 4mg, (once in a month) are continuing.
7. The latest report as on 14/9/2019 is also suggestive of VGPR.
8. Factor-VIII and vWF again tested on 11/10/2019. It shows that Factor-VIII is now changed into moderate disorder.

Is it advisable to take red wine? What quantity is beneficial. I was taking one or two peg of Smrinnoff once in a month or so. Is it advisable to take? Manny

Hi Manny-

Two things. First, I will reply to your question about red wine consumption.

“Is it advisable to take red wine? What quantity is beneficial. I was taking one or two peg of Smrinnoff once in a month or so. Is it advisable to take?”

Research shows that alcohol of any type, of any amount, increases a person’s risk of cancer. In the case of a MM patient, alcohol increases your risk of relapse. To complicate your situation, you have undergone a great deal of chemotherapy aka toxicity. This means that your liver has been damaged. Your liver is the organ that will process any alcohol that you consume.

Having said all the above, living with an incurable cancer, multiple myeloma, is difficult, stressful, tough on you. As you read from the post, I drink a glass of red wine 2-3 times a week for dinner.

My point is that if MM survivors consume alcohol, we increase our risk of both a MM relapse as well as a treatment-related secondary cancer. Yet, red wine may relax us. You have to make your own decision as to your alcohol consumption. I am comfortable with my own consumption of 2-3 glasses of red wine weekly.

Also, I don’t know what a “peg” of vodka is. I assume a peg is a shot (small glass of straight vodka. My logic above for wine is the same for 1 or 2 shots of vodka every month. You run slight risks yet you may be tense living with MM.

Autologous Stem Cell Transplantation vs. Low-dose Revlimid and Dex.

If I understand your email below, you intended to have an ASCT but have not yet. Instead, you are undergoing low-dose Revlimid and dexamethasone. If this is the case, please consider NOT having an ASCT and simply continuing low-dose Revlimid.

Here is my thinking-

Studies confirm that the average overall survival (OS- length of life) of a MM patient is the same whether they achieve complete remission or very good partial remission (VGPR). You achieved CR and then VGPR after your induction therapy. This is good. You did not have to deal with the damage causes by an ASCT.

Further, studies confirm that low-dose maintenance therapy results in longer OS for patients in your situation.

My belief is that you have NO overall survival benefit by having an ASCT. Please don’t take my word for it. Ask your oncologist what you will gain by undergoing a high-risk, high toxicity, expensive therapy like ASCT. You appear to be doing very well on low-dose maintenance therapy.

Let me know if you have any questions.

Hang in there,

David Emerson

MM Survivor
MM Coach
Director PeopleBeatingCancer

Recommended Reading:

Outcomes with early response to first-line treatment in patients with newly diagnosed multiple myeloma

“Rapid or late achievement of VGPR or better with first-line treatment does not affect long-term survival outcomes…

Patients who achieved VGPR or better as overall best response had significantly better PFS…

In conclusion, our data support that achievement of a deep response after first-line treatment is prognostic for improved long-term outcomes. However, the rapidity of achievement of this response, whether early or late during the course of the treatment, does not impact survival…”

Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission

Multiple Myeloma Therapy- Low-dose Maintenance vs. Stem Cell Transplant?

“However, the rapidity of achievement of this response (VGPR or better), whether early or late during the course of the treatment, does not impact survival…”

Outcomes with early response to first-line treatment in patients with newly diagnosed multiple myeloma

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