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Myeloma and Anemia Care

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Myeloma and anemia care, according to the paper linked below, are often dismissed . Possibly because both MM itself, chemotherapy regimens, vitamin deficiencies and/or non-conventional supplementation such as curcumin, all can contribute to a MM patient’s anemia.

When consulting with a NDMM patient recently, I was informed that the MM patient’s anemia was identified but her oncologist was not taking steps to understand what was causing the patient’s deficiency.

Was addressing both myeloma and anemia care at the same time too difficult? The NDMM patient had not yet determined her therapy plan. Was this the reason why her oncologist wasn’t acting on her anemia?


What are the possible causes of anemia to the myeloma patient?

  • Bone Marrow Infiltration: Multiple myeloma involves the proliferation of malignant plasma cells in the bone marrow. These cells can crowd out normal blood-producing cells, leading to reduced production of red blood cells (RBCs).
  • Renal Insufficiency: Myeloma can lead to kidney damage through the deposition of light chains (Bence Jones proteins) in the kidneys. This damage can reduce the production of erythropoietin, a hormone produced by the kidneys that stimulates RBC production in the bone marrow.
  • Chronic Disease: Chronic inflammation associated with multiple myeloma can lead to anemia of chronic disease. In this condition, inflammatory cytokines interfere with iron metabolism and reduce RBC production.
  • Nutritional Deficiencies: Patients with multiple myeloma may have poor nutritional status, leading to deficiencies in essential nutrients such as iron, vitamin B12, and folate, which are necessary for RBC production.
  • Chemotherapy and Radiation Therapy: Treatments for multiple myeloma, such as chemotherapy and radiation therapy, can damage the bone marrow and decrease RBC production.
  • Hemolysis: In some cases, multiple myeloma can cause hemolytic anemia, where RBCs are destroyed faster than they can be produced.
  • Blood Loss: Gastrointestinal bleeding or other forms of bleeding can also contribute to anemia in myeloma patients.
  • Infection: Frequent infections, which are common in myeloma patients due to immune system compromise, can exacerbate anemia.

I am a long-term MM survivor. Though I’ve been in CR since early ’99, my energy has never returned to normal. Unfortunately, I have no idea where my counts are (RBC, hemo, hemato, etc.).

The only course of action I can offer myeloma patients and anemia care, is to take charge and advocate for themselves if they find themselves in this situation.

Myeloma and anemia care, in my experience, falls into the category of diagnostic information. Meaning, the oncologist in charge of the NDMM patient’s care must figure out what is causing the patient’s anemia and address the problem.  There is no other way to say it.

If you are interested in learning more about both conventional and non-conventional MM therapies email me at David.PeopleBeatingCancer@gmail.com

thank you,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Most Cancer Patients Don’t Receive Recommended Anemia Care

Anemia occurs frequently in patients with cancer, with estimates reaching as high as 90% in those with solid tumors. The red blood cell disorder, which may develop because of tumor-related features or the cancer treatment, can lead to worse quality of life and survival.

Given the prevalence and consequences of anemia in this population, the National Comprehensive Cancer Network (NCCN) recommends routine follow-up evaluations for patients with hemoglobin levels ≤ 11 g/dL.

Research shows, however, that many physicians do not adhere to the NCCN guidelines. Most patients — more than 60% in the US — don’t receive thorough anemia assessments, and even among those who do, fewer than half (about 40%) receive treatment…

Operating Outside the Guidelines

The NCCN guidelines define anemia as a hemoglobin level ≤ 11 g/dL and recommend that patients undergo further workup to determine the cause — an iron or vitamin deficiency or a bone marrow issue, for instance — and best treatment for the condition.

Depending on the cause, treatments may include a blood transfusion, erythropoietin therapy, intravenous or oral iron supplementation, or vitamin B12 or folate supplementation.

“Anemia is a common aspect of oncologic care and is something that should be evaluated and managed as part of a comprehensive cancer program,..”

But a growing body of evidence indicates that is not happening regularly.

Previous research shows that many patients don’t receive adequate anemia testing or treatment. In a 2021 study, for instance, Prescott and colleagues found low rates of compliance with NCCN anemia guidelines among patients with gynecologic cancers: Only one third of patients received NCCN-recommended evaluations for anemia and 42% received treatment.

A more recent retrospective study, published in the Journal of the National Comprehensive Cancer Network earlier this year, confirmed high rates of anemia and low rates of follow-up evaluations and treatment in a larger group of patients with solid tumors…

The results confirm a high prevalence of anemia in patients with cancer and low compliance with NCCN guidelines for evaluating and treating the condition, the authors concluded.

Findings from another retrospective study, published earlier this year, indicate that issues with anemia testing and treatment are not limited to the US…

“Anemia assessment is inadequate, transfusion rates too high, and iron and erythropoietin stimulating agent therapy too infrequent,..”

The implications of failing to evaluate or treat patients can be serious, Prescott added. Left untreated, anemia may lead to worse survival or affect quality of life…

As Link demonstrated in his study, patients who receive guideline-concordant diagnostics and treatment do better. The researchers found providing appropriate treatment for anemia can improve patients’ quality of life…

“Anemia diagnostics is a relatively straightforward process that does not require significant financial investment,” and oncology teams should have regular training on anemia diagnostics and therapy to raise awareness of the problem and simple solutions, Link said…”

 

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