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Pre or Multiple Myeloma Diagnosis- High-Risk Plasmacytoma- PreHabilitation!
Prehabilitation is an evidence-based process that occurs in the time between diagnosis and the start of acute care. The goal is to prepare a patient with multiple myeloma as much as possible…”
Hi David-My father has solitary bone plasmacytoma in his sacrum. The plasmacytoma which measure in diameter around 5 cm and he was having that symptoms from last two year with some neurological defect. He is 60 year old and have mild diabetes.
My father has no M-spike but has a high light chain ratio. Normal markers are:
- Beta 2 Microglobulin
- Calcium,
- Kidney function,
- Liver function,
- CBC (complete blood count).
On his PET CT scan he have two more lytic lesion which are FDG, non avid so doctor prescribe him chemotherapy instead of radiotherapy and said he have high risk of progression due to presence of lytic lesion though not necessary.
Do you think non FDG avid lesion might be from something other then myeloma as they are FDG non avid and by using this evidence based therapy can we halt the process of progression? Manny
Dear Manny-
I am sorry to read of your father’s single bone plasmycytoma (SBP) diagnosis. Keep in mind however, that this diagnosis technically is “pre-myeloma” and not yet a diagnosis of full-blown MM. According to research, a small percentage of SBP patients never develop MM. Further, a diagnosis of pre-MM includes a much better prognosis. You father may not require chemotherapy at this early stage.
In order to properly reply to your questions below I will enumerate each below-
1) “My father has solitary bone sacrum”
This is where my SBP was as well when I was first diagnosed.
2) “Plasmacytoma which measure in diameter around 5 cm and he was having that symptoms from last two year with some neurological defect.”
I agree with your oncologist that radiation to the sacrum can cause RILP- it did with me. We can discuss this further if you care to.
3) “He is 60 year old and have mild diabetes.”
Steroids such as dexamethasone increase blood glucose. While your dad is young as MM patients go (good), I recommend you consider any chemotherapy regimens carefully.
4) “He has no M spike but have some high light chain ratio.His Beta 2 Microglobulin is normal and and calcium ,kidney function, liver function,CBC are normal.”
As I suspected, your dad is pre-MM, not full MM. However, evidence of “up-take” on the FDG PET scan is what is telling your oncologist that your dad is high-risk of pre-MM developing into frank MM. This is exactly what happened to me…
5) “On his PET CT scan he have two more lytic lesion which are Fdg non avid so doctor prescribe him chemotherapy instead of radiotherapy and said he have high risk of progression due to presence of lytic lesion though not necessary. “
The key issue for you to consider based on your dad’s high-risk status is the aggressiveness, the amount of toxicity he undergoes. Please consider “pre-habilitation.”
6) “Do you think non FDG avid lesion might be from something other then myeloma as they are FDG non avid”
Without knowing more its impossible for me to say. However, I think it is best to consider your dad to be high-risk and plan for progression to frank MM. This way, you can prepare evidence-based but non-toxic therapies to enhance low-dose chemotherapy.
7) ” by using this evidence based therapy can we halt the process of progression?”
By beginning a regimen of evidence-based, non-toxic MM therapies, your dad may slow or halt progresstion to frank MM and he will also pre-habilitate. Further, by beginning evidence-based, integrative therapies, your dad will also enhance the efficacy of any chemotherapy he undergoes.
At this point Mohd, I suggest we design an evidence-based, non-conventional therapy plan for your dad that will serve to either prevent or slow progression to MM and/or pre-habilitate him in case he does undergo toxic therapies.
The MM CC program includes guides (similar to the 3 I emailed to you previously) covering:
- Integrative therapies,
- Complementary therapies
- Anti-MM supplementation (curcumin, resveratrol, etc.),
- Lifestyle therapies,
- Mind-body therapies
- Caregiver issues
and others.
Let me know if you have any questions.
David Emerson
- MM Survivor
- MM Coach
- Director PeopleBeatingCancer
Recommended Reading:
- MRD- Multiple Myeloma Pre-Habilitation-
- Cancer Coaching Testimonials- PeopleBeatingCancer
- Multiple Myeloma Therapy- Curcumin- Evidence-based, Integrative, Non-toxic
Multiple Myeloma and Type 2 Diabetes Mellitus: A Clinical Challenge
“Poorly controlled type 2 diabetes mellitus in patients with multiple myeloma (MM) may increase the risk of adverse cardiovascular outcomes, kidney damage, and peripheral neuropathy. Considering the effect of medications to treat MM on blood glucose control may be an important part of choosing a treatment regimen for some patients.
Type 2 diabetes mellitus (T2DM) may complicate management of patients with multiple myeloma (MM), according to an article published in the International Journal of Hematology-Oncology and Stem Cell Research. The authors estimated that 11% to 22% of patients with MM also have T2DM.
MM places patients at risk for kidney disease, anemia, hypercalcemia, and bone deterioration. The risk of kidney disease, which is a common long-term comorbidity of T2DM, may be compounded in patients with both T2DM and MM. In addition, both T2DM and MM independently increase the risk of coronary heart disease and stroke. The additive effect of poorly controlled T2DM in patients with MM may further increase the risk of these adverse outcomes…”
An Ounce of Prevention: Cancer Prehabilitation
“Prehabilitation is a growing service in many cancer centers that helps patients prepare for acute care and long-term survivorship. It enables the care team to consider what will change in patients’ lives because of treatment and how the team can help them face those changes.
Nurses and nurse navigators play a significant role in advocating for prehabilitation and other services that can help preserve patients’ quality of life…
Prehabilitation is an evidence-based process that occurs in the time between diagnosis and the start of acute care. The goal is to prepare a patient with cancer as much as possible…”
Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes.
“This is the first review of cancer prehabilitation, and the purpose was to describe early studies in the noncancer population and then the historical focus in cancer patients on aerobic conditioning and building strength and stamina through an appropriate exercise regimen.
More recent research shows that opportunities exist to use other unimodal or multimodal prehabilitation interventions to decrease morbidity, improve physical and psychological health outcomes, increase the number of potential treatment options, decrease hospital readmissions, and reduce both direct and indirect healthcare costs attributed to cancer…”