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“The high-dose (dexamethasone) regimen came up very short, with remarkably low survival rate compared with the low-dose regimen,” 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…
“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…”