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Multiple Myeloma – Treatment-Related Cancer?

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Should we treat patients with myeloma with multidrug, multitransplant combinations with the goal of…recognizing that the risk of adverse events and effect on quality of life will be substantial?”

If you have been treated for multiple myeloma and subsequently developed a secondary or treatment-related cancer (your chemo caused the cancer), this blog post is for you.

  • Autologous Stem Cell Transplant- the patient’s own stem cells are used for the transplant
  • Allogeneic Stem Cell Transplant- a donor’s stem cells are used for the transplant

The study linked and excerpted below offers a clear example of how and why I disagree fundamentally with how conventional myeloma oncology treats multiple myeloma patients.

Let me explain. The following is what I understand from the study.

  • Multiple Myeloma patients are living longer-
  • Multiple Myeloma treatment is more aggressive, more chemotherapy,  more toxic-
  • Secondary cancers (treatment-related cancer), caused by more aggressive, more toxic chemotherapy, are increasing-
  • A little more than half of the MM survivors with a treatment-related cancer lived for two (2) years after having an Allogeneic Stem Cell Transplant-

To put all the above in everyday language:

I am diagnosed with MM, an incurable blood cancer. I undergo the FDA approved standard-of-care of induction therapy, an autologous stem cell transplant and maintenance therapy.  The Induction chemo and ASCT is difficult but I get through it.

My chemo causes a treatment-related cancer. Even though my FDA approved Standard-Of-Care treatment plan was hell to go through, expensive, changed my life forever and caused another incurable blood cancer, my board certified oncologist is recommending an even more hellish transplant aka aggressive, high-dose chemotherapy.

Oh, and, I’ll live with months of side effects and hopefully live for at least two more years.

Am I missing something here?!?

I’ve linked and excerpted what I consider the central philosophy in MM treatment- “Treatment of MM- Cure vs. Control.” While those MM patients who achieve above average outcomes, few side effects, etc. would probably favor the curative approach taken by conventional oncology.

But those MM survivors who develop treatment-related secondary cancer are NOT these people. Meaning, the MM patient who lives through aggressive, high-dose chemotherapy only to then develop another blood cancer will NOT be in favor of the curative approach to MM treatment.

And would probably not want to undergo an even more aggressive stem cell transplant. But maybe I’m missing something here.

What would you do?


David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

PeopleBeatingCancer Side Effects Program

Allogeneic Transplantation May Improve Disease-Free Survival for Therapy-Related Hematologic Malignancies After Multiple Myeloma

“A retrospective study suggests that allogeneic hematopoietic stem cell transplantation (HCT) may support disease-free survival for patients with certain therapy-related hematologic malignancies following treatment for multiple myeloma (MM)…

The study investigators explained in their report that:

  • life expectancy has increased over time for patients with MM,
  • but with a higher risk of secondary malignancies, including therapy-related malignancies.

The researchers also explained that their heavily pretreated condition, in addition to other factors, can contribute to worse outcomes for patients with therapy-related hematologic malignancies following MM.

However, they noted, there has been limited research involving allogeneic HCT outcomes in these patients…

The analysis included patients treated at Princess Margaret Cancer Center at the University of Toronto in Toronto, Canada. Patients had been previously treated for MM and subsequently developed:

  • therapy-related myelodysplastic syndrome
  • acute myeloid leukemia (t-MDS/AML),
  • therapy-related acute lymphoblastic leukemia (t-ALL),
  • or therapy-related chronic myelomonocytic leukemia (t-CMML)…

Patients received allogeneic HCT for these therapy-related malignancies and were evaluated for survival outcomes, clinical and laboratory characteristics, and features related to MM and its treatment…

Allogeneic HCT involved human leukocyte antigen-matched siblings in 30% of transplants, unrelated donors in 60%, and haploidentical donors in 10%…

  • The 2-year overall survival (OS) rate was 53.1%,
  • The 2-year relapse-free survival rate was 47.2%.
  • The 2-year cumulative incidence of relapse (CIR) was 15.0%,
  • The 2-year nonrelapse mortality rate was 35.0%.

For patients surviving more than 100 days after allogeneic HCT, the median follow-up time was 33 months.

A nonsignificant trend was observed of a better 2-year OS rate for patients with t-ALL (66.7%) than for patients with t-MDS/AML (42.7%; P =.36), with these patient groups showing a similar pattern for 2-year CIR (0% vs 15.4%, respectively; P =.33). Multivariate analyses did not reveal factors that appeared to be predictors of poor survival outcomes in patients with t-MDS/AML or t-ALL.

“Allogeneic HCT should be offered to patients with therapy-related acute leukemias after MM who are in remission and have a good performance status,” the study investigators concluded in their report.”

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?

To be sure, if cure were known to be possible (with a reasonable probability) in myeloma, it would undoubtedly be the preferred therapeutic goal of most patients and physicians. But this is not the case. Myeloma is generally not considered a curable disease; however, new definitions of cure have been suggested, including operational cure, which is defined as a sustained complete response (CR) for a prolonged period.,

Cure vs control is debated because the strategies currently being tested are not truly curative but rather are intended to maximize response rates in the hope that they will translate into an operational cure for a subset of patients…”




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