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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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T-Cell Exhaustion- Myeloma

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Though the concept of T-cell exhaustion is not well known in the world of multiple myeloma, it is prevelent in other health challenges such as:

According to the research linked below, cancer causes T-cell exhaustion. In addition, chemotherapy and radiation cause senescence.

The FDA approved standard-of-care therapy plan for all newly diagnosed multiple myeloma patients is a lot of toxicity. 6-8 rounds of DVRd followed by an ASCT followed by maintenance therapy is a lot of chemo. When a myeloma (MM) patient relapses, he/she undergoes another triplet or quadruplet usually of a stronger generation of chemo.

Eventually, does round after round of therapy and relapse after relapse culminate in multi-drug resistance? Or I should say, is it the accumulation of exhausted T-cells that lead to multi-drug resistance? Because MM patients undergo round after round of chemo causing senescence and stronger and stronger MM cells, do multiple myeloma patients experience t-cell exhaustion leading to relapse after relapse and MDR?

Could this be the reason why MM is incurable? Could there be a better way of managing multiple myeloma?

I’ve displayed  the first two articles linked and excerpted below in an effort to explain “T-cell exhaustion.” I did this simply because I found this concept to be confusing.

I’ve linked and excerpted the third article below because it explains how multiple myeloma may be different from other cancers when it comes of t-cell exhaustion. Basically the idea is that cancer causes t-cell exhaustion and chemo causes senescence. The MM patient experiences repeated remission and relapse of their cancer which causes more and more T-cells to become exhausted.

Could increased t-cell exhaustion be a reason why our blood cancer relapses over and over again until be reach multi-drug resistance, end-stage and die?

The third and fourth articles linked and excerpted below explain the benefit of certain non-toxic therapies for enhancing a person’s immune system.

  • Exercise
  • Nutrition
  • Supplementation
  • Lifestyle Therapies


Please don’t misunderstand me. Years of experience have taught me that there are times in the life of a MM patient when he/she must undergo toxic therapy- either chemo or radiation. The issue I’m questioning is the amount or dose of that toxic therapy.

I am questioning the incredible toxicity that MM patients are pushed to undergo again and again.

To learn more about toxicity in cancer therapy read the posts linked below-

Can cancer patients and survivors pursue non-toxic therapies that strengthen our fatigued or exhausted t-cells? Can cancer patients take nutritional supplementation cited to reduce inflammation?  Can cancer survivors strengthen our immune function in order to reduce our risk of relapse as well as reduce the risk of secondary cancers?

Thank you

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

T cell exhaustion

“T cell exhaustion is a state of T cell dysfunction that arises during many chronic infections and cancer. It is defined by poor effector function, sustained expression of inhibitory receptors and a transcriptional state distinct from that of functional effector or memory T cells. Exhaustion prevents optimal control of infection and tumors. Recently, a clearer picture of the functional and phenotypic profile of exhausted T cells has emerged and T cell exhaustion has been defined in many experimental and clinical settings…”

T-cell exhaustion in the tumor microenvironment


  • T-cell exhaustion is a hyporesponsive state of T cells in chronic environment, with increased inhibitory receptors, decreased effector cytokines and impaired cytotoxicity.
  • Most T cells in tumor microenvironment are exhausted, leading to cancer immune evasion.
  • PD-1 is the major inhibitory receptor regulating T-cell exhaustion, T cells with high PD-1 expression lose the ability to eliminate cancer.
  • Reversing T-cell exhaustion represents an inspiring strategy to treat cancer.

T cells in multiple myeloma display features of exhaustion and senescence at the tumor site


In this study, we show that the percentages of CD8+ effector T cells especially at the tumor site, i.e., the bone marrow, of myeloma patients are increased but cells are functionally severely impaired and display several features of exhaustion and senescence.

Whereas expression of checkpoint inhibitory molecules is retained during the course of treatment, senescent T cell-marker CD57 appears to be downregulated.

These data clearly show that several avenues for the reactivation of the immune response in multiple myeloma will finally be needed to develop novel successful therapies.

Roswell Park Study is First to Show That Exercise Strengthens Immune System in Multiple Myeloma Patients

“The results of that trial were shared earlier this summer, “T cell exhaustion is lower after a physical activity intervention in multiple myeloma patients…” 

“With these encouraging results from our pilot study, we have been able to show for the first time in myeloma patients that the immune system can be influenced by lifestyle interventions like supervised exercises…”

The study focuses on CD4+ and CD8+ T cells — white blood cells that are part of the immune system and capable of fighting cancer. When those cells are exhausted, they become too weak to sustain the attack. While preclinical studies have shown that exercise can reduce immune exhaustion, few studies have examined how exercise affects biomarkers that measure immune exhaustion in cancer patients, especially those with multiple myeloma…

The research team used flow cytometry, a technique used to identify cell properties, to determine how many exhausted and non-exhausted T cells participants had before and after the intervention. At the end of the six-month exercise intervention, they found that the typical participant had a less-exhausted T-cell profile than at baseline…

Non-chemotherapeutic Interventions for the Improvement of Quality of Life and Immune Function in Patients With Multiple Myeloma

“This clinical trial investigates the effect of non-chemotherapeutic interventions in patients with multiple myeloma. Non-chemotherapeutic interventions such as physical activity and nutritional interventions (e.g., modifications in diet) have been shown to positively affect the immune system and improve overall quality of life…”







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