Reducing Myeloma Chemo Doses

What happens if you reduce myeloma chemo doses? Anyone who has undergone chemo understands what side effects are. Some side effects are worse than others. Some side effects can make the MM patient want to stop the therapy altogether.

What is more important to the MM patient- quantity or quality of life?

The overall issues to be understood are:

Historically oncology has adopted a “maximum tolerated dose” approach-
FDA approval is based on specific dosing-
oncology adheres to FDA standards-

What is the MM patient do to? We’ve all heard, read or seen for ourselves what aggressive chemo can do to patients. Half of all newly diagnosed myeloma patients are over the age of 70. Aggressive toxicity????

Two easy answers are outlined below. I undergo acupuncture, CBD oil, exercise and supplement in order to reduce my chronic pain. Further, according to the first two studies linked below, both dexamethasone and revlimid, two common MM therapies, can be dose reduced with relatively few consequences.

Mistletoe and Ginger have been shown to reduce nausea. A number of FDA approved heart medications have been shown to reduce the risk of chemotherapy-induced cardiomyopathy.

What are some non-conventional therapies shown to reduce chemotherapy side effects?

1. Acupuncture

Evidence: Studies suggest acupuncture can reduce chemotherapy-induced nausea, vomiting, and peripheral neuropathy.
Mechanism: It may stimulate nerves and release endorphins, improving overall well-being.

2. Mind-Body Practices

Meditation and Mindfulness: Reduces stress, anxiety, and insomnia associated with chemotherapy.
Yoga and Tai Chi: Improves energy levels, reduces fatigue, and enhances quality of life.
Hypnotherapy: May help with managing anticipatory nausea and anxiety.

3. Nutritional Support

Ginger: Effective in reducing chemotherapy-induced nausea.
Omega-3 Fatty Acids: May reduce inflammation and neuropathy symptoms.
Probiotics: Can help manage chemotherapy-related diarrhea and gut health.

4. Herbal Medicine

Curcumin (from turmeric): Shows promise in reducing inflammation and protecting healthy cells during chemotherapy.
Ashwagandha: May help reduce fatigue and enhance overall resilience.
Caution: Herbal supplements can interact with chemotherapy drugs; consult a healthcare provider before use.

5. Physical Activity

Regular exercise, tailored to individual capacity, has been shown to reduce fatigue and improve mood and physical function during and after chemotherapy.

6. Aromatherapy

Essential oils like lavender or peppermint may help manage stress, nausea, or headaches.

7. Music and Art Therapy

Can provide emotional relief, reduce anxiety, and improve overall mood during treatment.

8. Cryotherapy

Cold Caps: Used during chemotherapy to reduce hair loss.
Cold Gloves/Socks: Can reduce the risk of chemotherapy-induced neuropathy.

9. Reiki and Therapeutic Touch

May promote relaxation, reduce stress, and provide emotional support.

10. Cannabis and CBD Products

May alleviate nausea, pain, and appetite loss, though legality and accessibility vary by region.

I am convinced that my side effects were the result of aggressive dosing on my oncologists part. I wish I knew then what I know now.

In my experience working with myeloma patients, working directly with their oncologists is the only way to work with therapies not discussed above or below. Meaning, if, for instance, darzelex is overwhelming you, it is up to your oncologist to reduce your dose.

For the record, my understanding is that all therapies approved by the FDA can be prescribed in any dose by board certified medical doctors. They may not want to but they can lower the dose of any FDA approved regimen.

My thinking and experience is that reduced myeloma chemotherapy is better than living a miserable life. I am curious to read what you think.

Email me at David.PeopleBeatingCancer@gmail.com with questions about multiple myeloma, dosing, side effects, anything.

Hang in there,

David Emerson

MM Survivor
MM Cancer Coach
Director PeopleBeatingCancer

Dexamethasone dose intensity does not impact outcomes in newly diagnosed multiple myeloma: a secondary SWOG analysis

“Key Points

Dexamethasone dose reductions below 40-60 milligrams weekly are common in multiple myeloma, even for patients enrolled on clinical trials.
Dexamethasone dose reductions did not impact PFS or OS in newly diagnosed multiple myeloma in multivariate analyses.

Dexamethasone is a key component of induction for newly diagnosed multiple myeloma (NDMM) despite common toxicities including hyperglycemia and insomnia.

In the randomized ECOG E4A03 trial, dexamethasone 40 milligrams (mg) once weekly was associated with lower mortality than higher doses of dexamethasone. However, the performance of dexamethasone dose reductions below this threshold with regard to progression-free survival (PFS) and overall survival (OS) in NDMM have not been fully characterized.

We conducted a secondary pooled analysis of the S0777 and S1211 SWOG studies of NDMM, which employed lenalidomide-dexamethasone (Rd) alone with or without bortezomib (VRd) and with or without elotuzumab (Elo-VRd).

Planned dexamethasone intensity was 40-60 mg weekly in all arms. Patients were categorized into FD-DEX (full-dose dexamethasone maintained throughout induction) or LD-DEX (lowered-dose dexamethasone or discontinuation; only permitted for Grade 3+ toxicities per both study protocols).

Of 541 evaluated patients, the LD-DEX group comprised 373 patients (69%). There was no difference in PFS or OS between the FD-DEX or LD-DEX groups, which were balanced in terms of age, stage, and performance status.

Predictors of PFS and OS in multivariate models were treatment arm, age ≥70, and thrombocytopenia; FD-DEX did not significantly improve either outcome.

Our study suggests that dexamethasone dose reductions are common in multiple myeloma, even within clinical trials.

Given dexamethasone’s many toxicities and unclear benefit in the era of modern treatment regimens, dexamethasone dose reduction during NDMM induction warrants further prospective study. NCT00644228, NCT01668719

Efficacy of dose-reduced lenalidomide in patients with refractory or recurrent multiple myeloma

Purpose: Introduction of lenalidomide has expanded the therapeutic options for refractory and recurrent multiple myeloma (MM) patients. However, the application of the approved doses may be difficult in some patients due to adverse effects.

Experimental design: Therefore, we evaluated the efficacy and safety of lenalidomide in 10 patients with relapsed and refractory MM who received a reduced dose due to leukopenia (4), polyneuropathy (1), muscle cramps (1), thrombocytopenia (1), renal insufficiency (1), at the request of patient (1), as continuous therapy (1), either from the beginning (2) or during treatment (8). They received lenalidomide at a mean (median) daily dose of 14 (15) mg/d once a day (days 1–21 every 28 days) in combination with dexamethasone at a mean (median) dose of 17.6 (28) mg per day (4–40 mg) on days 1–4, 9–12 and 17–20.

Results: Mean (median) duration of treatment with lenalidomide was 15.1 (15) months. Partial response or better was reported in seven and minimal response or better was reported in eight patients. Mean (median) values for time-to-progression (TTP) and for progression-free survival (PFS) were 8.7 (4) months. Mean overall survival (OS) has not been reached, all patients are still alive.

Conclusion: In conclusion, dose-reduced lenalidomide is an effective and well tolerated treatment for patients with recurrent or refractory MM who cannot tolerate full doses.

reduce myeloma chemo doses

Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission