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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 Relapsed- IgG has doubled- What Combo Next?

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“My IgG has doubled as has my M-spike, which I expected. However, I am not not sure what drug combination to follow next in my effort to manage my myeloma.”

Hi David- I hope you are doing well. It has been some time since we last spoke. Believe it or not it has been a year since I was diagnosed with Multiple Myeloma and my MM relapsed.

Went back for another 3 cycles and eventually had a reduction in my IgG and M-Band. I got myself into the Chinese CAR-T cell trial in September and got as far as them extracting my lymphocytes to target BCMA markers.
They cured about 80 people with about 74 going into full remission. Commercialisation is to happen in 2018. Celgene has also told me that they will have a CAR-T cure ready for commercialisation in 24 months. Great CAR-T trial results will be announced in December.
The Chinese trial unfortunately been suspended twice and now I am not sure when it will restart – if ever.
I am faced with a dilemma now that I have been off all meds since September, about 3 months.
My IgG has doubled as has my M-spike, which I expected. However, I am not not sure what drug combination to follow next whilst I wait.
I am considering Daratumumab/Dex/Rev or should it be Kyprolis/Dex/Rev or yet other combination.
Can you offer me some suggestion to consider before I decide with my doc this coming Monday?
Many thanks David. Stay safe. John

 Hi John- Sorry for the slow reply. On the one hand your oncologist might consider myeloma relapsed (failed RVd) yet, as you say your IgG has doubled. I don’t know if doubled means from 1-2 or 5-10. Probably somewhere in the middle… Therapy for relapsed MMers can be different from MMers with a more dramatic relapse. 
The studies linked above don’t say if one triplet (Darzalex or Kyprolis) is better than another. All the studies will tell you is that you will have an increased risk of collateral damage aka side effects.
As always I encourage you to minimize toxicity and increase antioxidant nutrition, and anti-MM lifestyle therapies.

My suggestion would be to choose the triplet based on the experience of your oncologist and his/her cancer center. In other words, your oncologist will have more experience eiter with darzalex or with kyprolis. Studies indicate that this experience can relate to significant benefits for the cancer patient (you).
Side effects, dosing, etc. can all relate to an oncologist’s experience. He/she will make a recommendation to you based on his/her comfort level. 
Does this make sense? 
David Emerson
  • Myeloma Survivor
  • MM Coach
  • Director PeopleBeatingCancer

Recommended Reading:

Efficacy of daratumumab‐based therapies in patients with relapsed, refractory multiple myeloma treated outside of clinical trials

“Despite the short follow‐up, our study shows that DCT provides good PFS and TTNT in heavily pretreated patients with MM who are refractory to multiple prior lines of therapy and largely ineligible for clinical trials.

The ORR and estimated PFS at 12 months observed in our heavily pretreated cohort of patients are much lower than those reported in CASTOR and POLLUX trials. With its approval for use in patients who are relapsed or refractory to at least 1 prior line of therapy, the patient population in whom daratumumab would be used would change.

However, until the time when the use of DCT earlier in the disease course becomes a routine practice, physicians are likely to encounter patients whose clinical characteristics resemble our patient group. In many parts of the world, daratumumab is still not available for use, and the physicians there would encounter patients similar to our cohort in the coming years as their practice patterns evolve.

Our results suggest that DCTs are effective salvage regimens and that their use earlier in the relapsed setting may improve clinical outcomes. The results of ongoing clinical trials that are evaluating efficacy of DCTs as primary therapies in treatment‐naïve patients may prove to be practice changing in MM.”

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