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Myeloma Chemotherapy- Myelosuppression

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Myelosuppression due to chemotherapy is one of the main challenges of conventional MM management (chemotherapy). Ironically, we MM survivors need to kill stem cells (MM) yet killing stem cells can be a problem for us.

Hi David-   I could use some more of your insight regarding my Multiple Myeloma treatment.   My Myeloma levels have been stable, but the medications continue to suppress my blood counts aka I face myelosuppression.

This morning my hemoglobin was down to 9.2, the lowest reading I have ever had, even though I had a shot of aranesp (Sp).  The shot never seems to bring my hemoglobin any higher that 10.4.

The doctor is fine with this but I am not.  I feel like an old man when my numbers get so low, although I keep pushing myself to exercise almost daily between weight training and running, although my running is now a slow shuffle of about 12.5 minutes per mile and it’s hard work to go up more than one flight of stairs.

I am still not on board with having a stem cell transplant, especially after having a consultation with Dr. Berenson.  Is there anything you can suggest that might help?   MM Patient

Dear MM Patient-

I am sorry to read of your therapy challenges. Myelosuppression due to chemotherapy is one of the main challenges of conventional MM management (chemotherapy). Ironically, we MM survivors need to kill stem cells (MM) yet killing stem cells can be a problem for us.

You mention hemoglobin (red blood cells) but reduced white blood cells and platelets can also be an issue. The term myelosuppression includes all three blood components.
I will first discuss this common side effect of chemotherapy and follow with possible therapies below. I must go on record by first saying that you and your oncologist are walking a fine line between your MM, monoclonal proteins, plasma cells, growing (bad) and your stem cells growing (good).
I can’t give you an evidence-based answer to your situation other than to say that you and your oncologist have to use your best judgment. As we have discussed over previously, you are weighing over vs. under treatment, quality of life vs. quantity of life, etc.
In my explanation below I will also talk about white blood cells and platelets so that you can keep an eye out for these forms of myelosupplression as well as red blood cell myelosuppression.
Lastly, the bottom article below speaks directly to your situation aka increasing red blood cell production. Consider iron, folic acid, vitamin A, C, frequent moderate exercise (walking…), and the many foods listed in the linked article.
As you know you can try aranesp as a synthetic form of epo.
The bottom line, in my experience, is that myelosuppression is like kidney and bone involvement. They is often there, MM survivors are almost always battling these symptoms, side effects.
Nutrition, supplementation and lifestyle therapies will help. If reduced red cells gets bad enough you can either reduce the chemotherapy or discontinue it completely for a time.
Let me know if you have any questions Vin.
Hang in there,
David Emerson
  • MM Survivor
  • MM Coach
  • Director PeopleBeatingCancer

Recommended Reading:

What is myelosuppression?

Myelosuppression describes the disrupted function of stem cells in the bone marrow. The bone marrow is responsible for making red and white blood cells and platelets.

As the bone marrow cannot function as it usually does, a person with myelosuppression may develop blood disorders, such as anemia, neutropenia, and thrombocytopenia. All of these blood disorders result from fewer red and white blood cells and platelets…


Anemia, which is a low number of red blood cells, is a condition that can cause the following symptoms:

Learn more about anemia.


Leukopenia is a low white blood cell count. Without adequate white blood cells, the body will find it more difficult to fight infections.

The symptoms of leukopenia include:

Learn more about leukopenia.


Low platelets, called thrombocytopenia, can cause the following symptoms:

Learn more about thrombocytopenia.

Understanding mortality in multiple myeloma: Findings of a European retrospective chart review

“In conclusion, this real‐world study of patients confirms that deaths at early treatment lines remain a key challenge in MM management.
It also highlights that death during early treatment lines is often not due to disease progression, and death commonly occurs during active treatment, indicating a need for improvements in supportive care. 
As patients reach later lines, death is more typically related to progression, owing to treatment resistance.24 Understanding factors associated with death in MM could help to increase the proportion of patients who reach later lines and inform new management approaches for improving patient survival…”
A lack of iron in the diet and, perhaps, other minerals and nutrients is the most common cause of a low red blood cell count. Eating foods rich in 5 ingredients may help to increase your red blood cell count, including iron, folic acid, vitamin B12, copper, and Vitamin A. You will also want to include copper, vitamins B12, B6, B9, C, and E. Lifestyle changes may also help to increase your red blood cell count, such as getting regular exercise. If these interventions fail, then your doctor may prescribe medication and blood transfusions to increase your red blood cell count…

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