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Myeloma Diagnosis- RVd, ASCT, Now or Later?
In conclusion, we found no statistically significant differences in (MM) PFS and OS between the early versus late ASCT groups.
Hi David-My father in-law just emailed me your newly-updated Multiple Myeloma Cancer Coaching course. Is this different from the user guides I purchased last March? I am happy to purchase anything new as we are looking for any helpful Information at this time. After a trying but successful induction of RVd (revlimid, velcade, dexamethasone) Allen and I need to learn more about autologous stem cell transplantation (ASCT).
Allen has gotten his M-spike down to .5 It has taken him 6 treatments of RVd (Revlimid, Velcade, dexamethasone) to get to this point. The last few treatments they switched Velcade to Kyprolis due to chemotherapy-induced peripheral neuropathy in Allen’s hands.
Allen had a big drop in his IGA of 1000 points this week. IGA is now 700. Dr Anderson at Dana-Farber wants to speak to him about his options at this point. Obviously an autologous stem cell transplant might be an opinion.
I know there are so many new options out there so I want to weigh them all. All this being said I don’t know .5 M spike is low enough to harvest cells which I think is a good idea to do.
If .5 isn’t low enough then that probably means more treatments, but we don’t want to cause anymore organ damage from toxic chemotherapy regimens.
I appreciate your thoughts on all this!
Also, let me know if I should purchase the new coaching course. Thank you and I hope all is well! Karen
Hi Karen,
The new MM CC course has some new info but the primary improvement to the program is video lessons aka actual coaching by me. People prefer watching videos over reading studies…
I explain much of what I wrote about in the previous MM CC guides. Though you will certainly learn more about MM, I can’t say that you should purchase the new MM CC program.
As for Allen’s current situation, based on your description of things it sounds as though you/he are typical MM patients/caregivers. By this I mean that chemo has gotten Allen’s m-spike and immunoglobulins to almost complete remission, almost normal once again. It sounds as though side effects (CIPN) are enough to alter his therapy plan. MM survivors can live with an m-spike under one for years.
I think you know enough of my overall MM philosophy to know that I am cautious when it comes to long-term damage from chemo.
I agree with you that more chemo (an ASCT) will probably cause more damage and according to research, will not add to overall survival.
I don’t mean that you should be confrontational with Dr. Anderson but it is certainly fair to ask him, pointedly, if an ASCT at this time, has been shown to increase overall survival. If, on average, you and Allen won’t enjoy a longer overall survival then I don’t see any real benefit and I do see real potential for organ damage from toxic chemotherapy.
I believe that a combination of non-toxic therapies and Dana-Farber (or careful use of toxic therapies from Dr. Anderson and D-F) is Allen’s best chance for the longest overall survival combined with quality of life. Living with chronic pain is awful. CIPN can be extremely painful.
I do think it makes sense to harvest stem cells. I consider this a sort of Boy Scout “be prepared” philosophy. You can freeze stem cells for years.
thanks
David Emerson
- MM Survivor
- MM Coach
- Director PeopleBeatingCancer
Recommended Reading:
Early versus delayed autologous stem cell transplantation in patients receiving novel therapies for Multiple Myeloma
“In conclusion, we found no statistically significant differences in PFS and OS between the early versus late ASCT groups. .
A major limitation of this study is that we do not know the reason(s) for the late referral for patients in the late ASCT. Reasons could be patient initial refusal, physician preference because patients were doing well with induction or initial feeling that patients may not be good candidates for ASCT.
Also, this study is a retrospective analysis and likely the number of patients may not be powered to attain statistical significance. We excluded patients who received maintenance treatment post ASCT as this was not balanced between the two groups. Although retrospective, these data support the ongoing prospective randomized trial examining this important question (NCT01191060, NCT 1208662, and NCT00551928).”