“The high-dose (dexamethasone) regimen came up very short, with remarkably low survival rate compared with the low-dose regimen,” he said…”
Hi David- I was diagnosed with Multiple Myeloma in 2018, I have gained about 20 lbs. I have also been diagnosed with steroid-induced diabetes. Considering various multiple myeloma treatments, what foods can help with weight loss , and what should I avoid. Thank you. Rose
I am sorry to learn of your mm diagnosis. I will link the MM CC Nutrition Guide below. My experience as a MM survivor is that anti-angiogenic foods combined with:
- moderate daily exercise,
- nutritional supplementation and
- lifestyle therapies (detox, whole body hyperthermia, others)
are needed to manage MM as well as manage toxicity from chemo.
Regarding dexamethasone and your diagnosis of steroid-induced diabetes, several things. I myself gained about 40 lbs. during my induction therapy. My induction therapy was the example used by Dr. Rajkumar in the article linked below.
While much of the discussion among MM patients, survivors and oncologists revolves around chemotherapy and its side effects, real damage can result from dexamethasone such as steroid-induced diabetes.
I admit that I don’t know your dose of dexamethasone. My assumption is that your oncologist prescribed the standard-of-care induction therapy of revlimid, velcade and dexamethasone (RVD). If you underwent the SOC dose for dexamethasone of 40 mg daily, consider asking your oncologist to lower your dose.
For that matter, depending on your age and stage of multiple myeloma at diagnosis, you may want to consider lower doses of chemotherapy as well as dexamethasone. You may reduce side effects from chemotherapy as well as steroid-induced diabetes.
- What was your stage at diagnosis? What were your symptoms? Bone pain? Kidney involvement?
- How is your health other than your MM?
I don’t mean to sound nosey. I’m trying to think through your prognosis and therapy plan.
Let me know, thanks. Hang in there,
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
“As so often happens in medical oncology “debates,” both speakers here at one of the sessions at the American School of Oncology’s Great Debates in Hematology meeting were in total agreement with one side of the argument—in this case the “no” position. Both speakers said that high-dose dexamethasone should not remain a part of most chemotherapy regimens for multiple myeloma…
I am actually much more aggressive than Dr. Richardson in how much I feel that high-dose dexamethasone is not something we should use for treatment of multiple myeloma, particularly in the newly diagnosed setting,” Dr. Rajkumar said. “The regimen carries a very high risk of side effects and a high risk of early mortality, particularly in the elderly population…”
Low-dose dexamethasone should be the default regimen for all induction regimens, including thalidomide-dexamethasone, lenalidomide-dexamethasone, bortezomib-dexamethasone, and any others that use dexamethasone, he said…
Start of ‘Whole High-Dose Dex Mania’
Historically, he explained, the introduction of the VAD regimen (vincristine-doxorubicin-dexamethasone) started the “whole high-dose dex mania,” when trials found that VAD produced a response rate in patients with refractory disease. It was later modified into an induction regimen that did not contain melphalan but did contain dexamethasone in high doses…
It was found in the early 1990s that high-dose dexamethasone alone was as effective as the full VAD regimen, and after that, high-dose dexamethasone became the standard regimen to which other regimens were compared.
Combination trials that followed did show that adding other agents to high-dose dexamethasone was superior in efficacy to high-dose dexamethasone alone…
Moving to high-dose versus low-dose dexamethasone, he cited the ECOG Phase-III E4A03 trial of high-dose vs low-dose lenalidomide, which he also led, as the only time there was a head-to-head competition of high-dose versus low-dose…
The high-dose regimen came up very short, with remarkably low survival rate compared with the low-dose regimen,” he said…
Days 1, 2, 4, 5, 8, 9, 11, and 12: Dexamethasone 40mg orally daily.
Days 1, 8, and 15: Dexamethasone 40mg orally daily.
“Curcumin, when used in a combination regimen in multiple myeloma patients, has comparable progression‐free survival without the adverse effects of steroid‐based combination therapies that is curcumin may be a viable alternative to corticosteroids in combination with an immunomodulatory drug or proteasome inhibitor…
The multitude of published studies, including an in vitro study carried out in our laboratory,16 suggest that curcumin can potentiate not only the cytotoxic effect of multiple agents used in the treatment of MM, but also enhance the chemo‐sensitizing effects of these agents. The implications arising from these observations may be of important clinical benefit: i) curcumin studies can be designed to assess the additive antimyeloma effects of curcumin to the current treatment protocols and ii) curcumin may be used as an alternative to corticosteroids in such protocols.
We show here that curcumin may act as a steroid‐sparing agent in patients with MM who are intolerant of Dex.
We demonstrate that curcumin in combination with other antimyeloma therapies was able to reduce paraprotein load by 38% and plasmacytosis by 59% over this study period. Multiple myeloma is a heterogenous disease from a cytogenetic abnormalities point of view.24 Eight of the 15 patients demonstrated high‐risk cytogenetic and FISH abnormalities with many of these showing evolution during the course of their illness. While three patients died during the course of this study, none of these had high‐risk cytogenetic abnormalities. Some of the surviving patients do have high‐risk cytogenetic and FISH abnormalities and despite this, continue to do well on the combination therapy.
This is the first reported case series of patients with MM who have been treated with adjuvant curcumin as opposed to Dex in combination with other antimyeloma agents…”