Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission
Multiple Myeloma an incurable disease, but I have spent the last 25 years in remission using a blend of conventional oncology and evidence-based nutrition, supplementation, and lifestyle therapies from peer-reviewed studies that your oncologist probably hasn't told you about.
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Myeloma- Stem-Cell Transplant or No?
Hi David – I am 12 weeks into an aggressive treatment with chemo, steroids, and other conventional therapies prescribed as induction therapy for my myeloma diagnosis. I am fast approaching stem-cell harvesting and one of two stem-cell transplants (ASCT) that have been prescribed to me. I am looking for a conversation about nutrition and more information in general about serving long-term with MM.
I want to thrive. I need more information. Andy
Hi Andy-
I am sorry to learn of your Multiple Myeloma diagnosis. The most effective way for me to understand your situation is for me to study your diagnostic testing info, CBC, SPEP, BMB, etc. and discuss your goals, think through your current and future therapy plans.
Your current induction therapy should stabilize you, bring you into complete remission hopefully. You may or may not need an ASCT. We can discuss that.
If you can send me your diagnostic info I can ask relevant questions, make recommendations.
Let me know, thanks.
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Hello David,
Thank you for your response. I have attached several screenshots of several test results. I will be seeing the transplant doc on Monday so I will have more recent results by next week. But these should give you a clearer picture.
Best regards, Andy
Hi Andy-
I have attached the MM CC nutrition guide below. I think it is a good idea for you to include anti-mm foods (anti-angiogenic nutrition) in your day.
Your diagnostic info looks pretty good aka VGPR (very good partial remission). If all of these tests were conducted last month (Dec.) then there is a good chance that your progress has continued a bit and you are in complete remission (m-spike of 0). A key issue for you and your hem/onc. to determine is if you are in VGPR, CR or MRD (minimal residual disease. Determining your response to your induction therapy will help you determine what next therapy steps you pursue.
If I interpret your original question to me, you are wondering if a double ASCT is the best therapy plan for you? If this is correct, you have several therapy choices to consider.
- Tandem ASCT
- Single ASCT
- ASCT later once you relapse-
- Only low-dose maintenance therapy-
- Stop all chemo- take chemo vacation-
Those are your five basic therapy choices. We can add/subtract elements but those are the basic choices. While conventional chemotherapy has been and will be a component of your therapy, the question for you to consider is the amount of chemo. Meaning the aggressiveness of your treatment now and in the future.
Because you have responded well to induction therapy (VGPR or better), I can make a case for evidence-based, non-toxic therapies for you to lengthen and deepen your remission aka progression-free survival (PFS). Low-dose maintenance therapy is the therapy plan designed to lengthen and deepen your remission. One therapy is conventional and one therapy is non-conventional.
In addition to antiangiogenic nutrition discussed in the nutrition guide, there are nutritional supplements and lifestyle therapies shown to also cause apoptosis to MM (kill MM).
I think it is a good idea for you to harvest your stem cells now regardless of whether or not you want to have an ASCT now, later, or ever. My point is that having relatively clean stem cells harvested just in case is always a good plan. At your appt. with your hem/onc. this Monday, he will probably push to set a date for your first ASCT. It is perfectly normal for you to only request the harvesting of your stem cells and to not commit to an ASCT at this point.
A couple more questions:
- What was your original diagnosis? MM yes, but what stage? Do you know what your m-spike was originally?
- Are you experiencing any side effects from chemo (peripheral neuropathy, fatigue, etc.)?
My suggestion is for you to meet with your hem/oncologist this Monday as planned, confirm your response to your induction therapy and schedule the harvesting of your stem cells. I think you should hold off committing to a single or double ASCT until we talk about non-toxic MM therapies.
Let me know if you are interested.
Thanks,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Recommended Reading:
- A Long-term Multiple Myeloma Survivor’s Diet, Nutrition Plan-
- Multiple Myeloma Diagnosis – A How-To Guide
- Multiple Myeloma Induction- RVD W/ or W/O ASCT?
Early or delayed transplantation for multiple myeloma in the era of novel therapy: does one size fit all?
“For the last 20 years, high-dose therapy with autologous stem cell transplantation (ASCT) for multiple myeloma has been considered a standard frontline treatment for younger patients with adequate organ function.
With the introduction of novel agents, specifically
- thalidomide,
- bortezomib,
- and lenalidomide,
the role of ASCT has changed in several ways.
First, novel agents have been incorporated successfully as induction regimens, increasing the response rate before ASCT, and are now being used as part of both consolidation and maintenance with the goal of extending progression-free and overall survival.
These approaches have shown considerable promise with significant improvements in outcome. Furthermore, the efficacy of novel therapeutics has also led to the investigation of these agents upfront without the immediate application of ASCT, and compelling preliminary results have been reported.
Next-generation novel agents and the use of monoclonal antibodies have raised the possibility of not only successful salvage strategies to facilitate delayed transplantation for younger patients, but also the prospect of an nontransplantation approach achieving the same outcome.
Moreover, this could be achieved without incurring acute toxicity or long-term complications that are inherent to high-dose alkylation, and melphalan exposure in particular.
At present, the role of ASCT has therefore become an area of debate: should it be used upfront in all eligible patients, or should it be used as a salvage treatment at the time of progression for patients achieving a high quality of response with initial therapy?
There is a clear need to derive a consensus that is useful for clinicians considering both protocol-directed and non-protocol-directed options for their patients. Participation in ongoing prospective randomized trials is considered vital.
While preliminary randomized data from studies in Europe favor early ASCT with novel agents, differences in both agents and the combinations used, as well as limited information on overall survival and benefit for specific patient subsets, suggest that one size does not fit all.
Specifically, the optimal approach to treatment of younger patients eligible for ASCT remains a key area for further research. A rigid approach to its use outside of a clinical study is difficult to justify and participation in prospective studies should be a priority.”