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Newly Diagnosed Multiple Myeloma- Low Dose? SOC?
“…other therapeutic elements (e. g., other maintenance strategies, consolidation, tandem transplantation,..) have to be decided on an individualized appraisal of risk and toxicities…”
My husband was diagnosed yesterday with Multiple Myeloma. Results from bone marrow biopsy: “Given the history of lytic bone lesions & the presence of anemia. Findings are compatible with overt Lambda-restricted Plasma Cell Myeloma (32%).”
Three months ago, he started having back pain and referred to surgeon (MRI, CT scan, DEXA) who found chronic lumbar compression fractures & osteopenia/osteoporosis where he was told to rest, put on pain killers and that he would not need surgery. He continued to have pain and was referred to endocrinologist and then oncologist where labs, x-rays and bone marrow biopsy were done.
They want to get him started on induction therapy: Velcade, Revlimid & Dexamethasone. Plus, an anti-viral for Shingles and possibly biphosphonates for Osteoporosis.
I ran across an article from you about specialists & he wants to get a 2nd opinion. Currently, we are on HMO and will be transferring to PPO at annual renewal 12/1/20, which would allow him to see Dr. Berensen in Los Angeles. That is 1 1/2 months away, but may be able to get a 2nd opinion from another specialist-Dr. Kanwarpal Kahlon before that. Not sure about starting treatment with 1 dr. only to transfer over to Dr. Berenson after 12/1/20.
Any feedback would be greatly appreciated. Thank you!
Hi Terry-
I will write the longer reply to you below that I mentioned in last night’s email. I will reply to specific comments that you made in your email to me.
Let me know if you have any questions.
“Plasma Cell Myeloma (32%)-“
“Plasma cell MM is multiple myeloma. The important issue is the percentage, 32%, written after the term. The issue is that the definition of MM is the presence in plasma cells (bone marrow). A diagnosis of MM is plasma cells in the marrow of 30% or more. Pre-MM is defined as less than 30%. Depending on your husband’s other issues, bone damage, kidney damage, freelight chain assay, etc., all together will combine to indicate his stage of MM.
“chronic lumbar compression fractures & osteopenia/osteoporosis-“
Your husband had bone involvement in his spine obviously. The issue is the best therapy to stabilize his spine. A procedure called kyphoplasty might be the best way to go (bone cement in the affected vertebra). As your health insurance if kyphoplasty is covered. Ask your oncologist about this procedure.
“They want to get him started on induction therapy: Velcade, Revlimid & Dexamethasone. Plus, an anti-viral for Shingles and possibly biphosphonates for Osteoporosis-“
The therapy they are talking about- RVD, bone drug (Bisphosponate) is what is referred to as the standard-of-care for newly diagnosed MM patients. I can’t speak for Dr. Berenson but my guess is that your husband, at an early stage, will do better, fewer side effects, less toxicity, with less chemotherapy. Dr. Berenson is the only MM specialist that I know of who takes a low-dose, less is more approach to MM management.
“allow him to see Dr. Berensen in Los Angeles-“
My point above is that you may not need to start, RVD. Or, I should say that RVD may be too much chemo, too much toxicity for your husband.
” but may be able to get a 2nd opinion from another specialist-Dr. Kanwarpal Kahlon”
Most oncologists practice the standard-of-care MM therapy plan- RVD, bisphosponate, autologous stem cell transplant, low dose maintenance therapy. While Dr. K may be an excellent MM specialist, there is no reason to tell you anything different than your current oncologist.
Another consideration is for your husband to pre-habilitate (supplementation, nutrition, NOW) in preparation for his SOC basic induction but undergo only enough courses (maybe two or three?) such that his numbers stabilize.
The SOC for induction is for oncologist to promote 4-6 rounds of RVD. Again, your husband may need only a course or two of RVD. And stabilize his spine as well. And then see Dr. Berenson and she what he says.
Hang in there,
David Emerson
MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer
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plasma cell myeloma
(PLAZ-muh sel MY-eh-LOH-muh)
A type of cancer that begins in plasma cells (white blood cells that produce antibodies). Also called Kahler disease, multiple myeloma, and myelomatosis.
Kyphoplasty for Patients With Multiple Myeloma is a Safe Surgical Procedure: Results From a Large Patient Cohort
“Introduction: Only in recent years has balloon kyphoplasty gained significance in the treatment of vertebral fractures as an adequate minimally invasive vertebral stabilization technique. Kyphoplasty has also increasingly been used to treat vertebral osteolyses caused by multiple myeloma (MM).
“Patients and Methods: In our cohort of 76 patients with MM with a total of 190 vertebral fractures treated with kyphoplasty, we performed a 30-day postoperative analysis of cement leakage, neurologic symptoms, pulmonary embolism, and infections.
Results: Painful osteolytic or fractured vertebrae or even imminent vertebral instability caused by osteolyses were seen as indications for kyphoplasty. One case of pulmonary embolism was observed because of cement leakage as the only postoperative complication.
Conclusion: By careful interdisciplinary indication setting and a standardized treatment model, kyphoplasty presents a very safe and effective procedure for the treatment of vertebral osteolyses and fractures caused by MM…”
Short overview on the current standard of treatment in newly diagnosed multiple myeloma
“While all transplant-eligible MM patients should receive a triplet induction therapy followed by autologous transplantation and, in most cases, lenalidomide maintenance, other therapeutic elements (e. g., other maintenance strategies, consolidation, tandem transplantation,..) have to be decided on an individualized appraisal of risk and toxicities…”