My Risk of Therapy-Related Secondary Cancers

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I believe my risk of therapy-related secondary cancer is high and increases annually. Because I haven’t had a secondary cancer in over 25 years post chemo and radiation, I think I’m doing something right.

Living with a “risk” of anything of only a percent or two is no big deal. I mean, we all have a risk of dying of 1% or 2% every time we get in a car. I’m talking about studies telling me that my risk of therapy-related secondary cancer is now almost 50% a year…and growing! And insult to injury, I live with this risk from the “potentially curative” therapies the FDA says are “safe and effective.”

Though I’ve been in complete remission (CR) from my original blood cancer multiple myeloma (MM) since early 1999, I don’t consider myself to be cured. According to conventional oncology MM is an incurable blood cancer. As such, I can relapse at any time.

I am more likely to die of therapy-related secondary cancers  caused by my many courses of local radiation as well as my induction, consolidation and autologous stem cell transplant chemotherapy regimens.

This blog post links to six of the most illustrative  blog posts that I’ve written and posted on PeopleBeatingCancer.org since I launched the Galen Foundation in June of 2004.

This post and linked posts explaining the causes of therapy-related secondary cancers as well as the many therapies I have pursued over the years to prevent secondary cancers is my attempt to address to my mantra: “I wish I knew then what I know now.”

Let me be clear. Many of the links below mention my blood cancer, multiple myeloma. Secondary cancers have nothing to do with the original or primary cancer. Treatment-related cancers are cancers that is caused by either radiation or chemotherapy given to treat the primary cancer.

  • Vincristine- 
  • Doxorubicin
  • Cytoxan/cyclophosphomide
  • Busulphan
  • Melphalan

My reasoning for listing each chemotherapy I had is that while a study may document a given chemo having a small risk of secondary cancer (see links below), most cancer patients undergo many chemotherapy regimens within a relatively short period of time. I know that I did. I underwent all five of the above chemo regimens over a period of 10 months.

If the cancer patient undergoes a hematopoietic stem cell transplant, he/she will certainly undergo several chemotherapy regimens, s0me at high doses, preceded by induction therapy of several more chemotherapy regimens.

I think it is possible, perhaps likely, that multiple chemo regimens over a short period of time greatly increase the risk of a secondary cancer. And that risk increases annually.

In my case, based on research, from my autologous stem cell transplant alone,  I calculate my risk of a treatment-related secondary cancer to be 20% annually after 20 years… and this risk grows annually.

Keep in mind- treatments such as aggressive chemotherapy and radiation or either an autologous or allogeneic stem cell transplant are promoted as “potentially curative” therapies. According to research, a substantial percentage of patients who undergo high-dose chemo will develop a treatment-related secondary cancer.

Benefit of this therapy? 

When I underwent my induction therapy of Vincristine, Adriamycin and Dexamethasone (VAD), there was about a 67% response rate- partial, complete. I was was a partial response. At the time (1995), this was standard induction therapy for MM. Knowing what I know now, I have a difficult time understanding why my oncologist prescribed such a damaging chemo cocktail.

I feel the same way about both melphalan and busulfan. Incredibly cardio-toxic chemotherapy regimens. I just don’t get why conventional oncology prescribes these destructive therapies.

Alternatives to these therapies?

From diagnosis of full multiple myeloma in 2/95 to being told I was “end-stage” in 9/97, I lived for 31 months. Assuming I would live for another 6-12 months in “end-stage” MM, I estimate I would live with aggressive, conventional treatments for about 43 months.

I know I’m biased but I have a difficult time thinking that aggressive, conventional therapies lengthened my life much, if at all.

Therapies to heal or prevent a therapy-induced secondary cancer?

More importantly, there are many evidence-based but non-toxic therapies to reduce my risk of a treatment-related secondary cancer? Yes. I do the therapies listed below each and every day. So far, so good.

  • anti-cancer nutrition,
  • anti-cancer supplementation and
  • anti-cancer lifestyle therapies-

all shown to reduce the risk of treatment-related secondary cancer. I know this to be true because I have read the research and follow the therapies daily, weekly, annually for years now.

If you have questions or comments please scroll down the page, post a question or comment and I will reply to you ASAP.

Thank you.

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director The Galen Foundation 

Recommended Reading:

Risk of Therapy-Related Second Cancer “Exponentially Higher”

“My point in writing this depressing blog post is:

  1. that  chemotherapy is toxic and causes very real short, long-term and late stage side effects. A therapy-related second cancer is a key example of this. Therefore you must work carefully with your oncologist to use the bare minimum of the chemo regimen that you need to manage your specific cancer.
  2. there are evidence-based, integrative theraies shown to reduce the toxicity of whatever chemotherapy you must take.
  3. there are evidence-based non-toxic therapies shown to reduce the risks of the cancer survivor’s risk of secondary cancers- I know because I pursue these therapies daily…”

Secondary Cancer in Multiple Myeloma Survivors

“Pediatric and AYA cancer survivors remain at increased risk for treatment-related subsequent neoplasms, even after the age of 40, according to a new study published online ahead of print in the Journal of Clinical Oncology…”

The issue is not about being a young cancer patient, I think the issue is about living for 20.30,40 plus years beyond high-dose, aggressive therapies and the long-term and late stage side effects of toxic therapies.

If my math is correct (I am working on healing my chemobrain…) the risk of a secondary cancer diagnosis after 30 years as a MM survivor is over 25 percent…annually…”

Stem Cell Transplant- Treatment-related Secondary Cancer

“We describe baseline incidence and risk factors for new cancers (treatment-related secondary cancer) in 4161 persons receiving autotransplants for multiple myelomain the United States from 1990 to 2010…”

Revlimid, Multiple Myeloma, Secondary Cancer

…various types of therapies (eg, oral alkylating therapy, myeloablative therapy used in conjunction with ASCT, radiotherapy, and revlimid (lenalidomide) to be associated with an excess of secondary cancer after multiple myeloma…”

Multiple Myeloma Survivor- Hemorrhagic Cystitis, Bladder Cancer

“Cyclophosphamide increases the risk of developing some kinds of cancers, which can occur years after taking this medication…Bladder cancer is the most common cancer related to cyclophosphamide”

Non-Hodgkins Lymphoma-“Continual Risk of Secondary Cancer”

“The study isn’t talking about a slight continual risk of treatment-related secondary cancer. Depending on the type of cancer and how long its been since you underwent conventional chemotherapy and/or radiation therapy, the study cites a 25-50% increeased risk…of a continual risk of a treatment-related secondary cancer…”


Frequency not reported: Second malignancies[Ref


Acute leukemia (e.g., acute myeloid leukemia, acute promyelocytic leukemia), myelodysplastic syndrome, secondary malignancies, bladder cancer, ureteric cancer


If experienced, these tend to have a Severe expression i

Acute Myeloid Leukemia, A Type Of Blood Cancer


These are rare but serious complications of busulfan therapy:

Increased risk of secondary cancer such as acute leukemia especially with long-term use of the drug.  Discuss this with your doctor.


“In most cases, a secondary cancer related to chemotherapy is a blood cancer (leukemia, lymphoma). This can occur years after treatment. This is most often associated with repeated treatments or high doses. Your provider will monitor your labs closely. Consider having a complete blood count with differential checked annually by your healthcare provider if you received high-risk therapies.”








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