Recently Diagnosed or Relapsed? Stop Looking For a Miracle Cure, and Use Evidence-Based Therapies To Enhance Your Treatment and Prolong Your Remission
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.
Click the orange button to the right to learn more about what you can start doing today.
- You are here:
- Home »
- Blog »
- Multiple Myeloma »
- Triple Class Refractory Myeloma
Triple Class Refractory Myeloma
What is triple class refractory myeloma? According to research triple-class refractory multiple myeloma (MM) refers to a stage of multiple myeloma where the disease has become resistant to all three main classes of multiple myeloma therapies: proteasome inhibitors (PIs), immunomodulatory agents (IMiDs), and anti-CD38 monoclonal antibodies (anti-CD38 mAbs).
The two studies linked and excerpted below outline many, if not all of the possible therapy options available to the triple class refractory myeloma patient.
The purpose of my posting the top study is to offer a more novel approach to treating triple-class refractory myeloma.
Outcomes of Triple Class Refractory Multiple Myeloma Patients | James Berenson, MD | ASH 2023
As a long-term MM survivor myself, I have to add a brief discussion of evidence-based non-conventional therapies such as”
- anti-mm nutrition
- nutritional supplementation and
- lifestyle therapies
all shown to enhance both the quality and quantity of life for triple-class refractor MM patients.
Email me at David.PeopleBeatingCancer@gmail.com with questions about managing your MM.
Good luck,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Outcomes of Triple Class Refractory Multiple Myeloma Patients: A Single Center Retrospective Study
Despite recent advances in the treatment of multiple myeloma (MM), the disease remains incurable. Recent studies suggest that patients who are triple class refractory (TCR) to a
- proteasome inhibitor (PI), (such as velcade)
- immunomodulatory agent (IMiD), (such as revlimid)
- and anti-CD38 monoclonal antibody (mAb) (such as darzalex)
have especially poor outcomes with a median overall survival (OS) of less than 1 year. However, studies with these results have been conducted in large academic institutions. In this study, we retrospectively analyzed outcomes among MM patients with TCR MM in a single clinic specializing in the care of patients with MM…
The first line of therapy administered following the development of TCR for the majority of patients (n= 108 [89%]) was retreatment with an IMID, PI, mAb, or a combination of agents from these drug classes. Thirteen patients (11%) were treated with a venetoclax- or alkylating agent-based combination therapy.
In addition, all except 2 patients received steroids as part of their first treatment after developing TCR. The regimen with the longest PFS was the combination of a mAB and steroids (median 9.0 mo) but only 6 patients were treated with this combination. The shortest PFS was among those retreated with a PI and steroids (n = 15; median 2.4 mo). The use of an IMID with steroids was the most frequently used combination treatment (n=32) with a median PFS of 3.4 mo.
CONCLUSION
Despite being refractory to a PI, IMID, and mAb, TCR patients in our single-center retrospective study showed a median OS of more than 2 years (25.5 mo) from the development of TCR.
This OS is the longest reported to date in this population of MM patients. Cytogenetic differences failed to predict both OS and PFS from the development of TCR. In addition, the number of prior lines of therapy did not predict PFS from their first treatment after showing TCR.
The time to development of TCR, however, did predict OS as patients who took longer to become TCR had a longer median OS. The results of this study show that time to becoming TCR is a prognostic factor for this group of patients. Our study shows that OS is considerably longer for patients with TCR than has been previously reported.
Clinical Management of Triple-Class Refractory Multiple Myeloma: A Review of Current Strategies and Emerging Therapies
“Conclusions
Treatment paradigms for relapsed or refractory myeloma have changed rapidly from the use of chemotherapeutics, to novel agents, and now immune-based therapies.
Myeloma that is refractory to an:
- immunomodulatory agent,
- a proteasome inhibitor,
- and monoclonal anti-CD38 antibody treatment (triple-class refractory)
myeloma has emerged as a pressing need to find new effective management strategies. The next generation of novel agents with new mechanisms of action, such as venetoclax and selinexor, has shown some activity in triple class refractory myeloma but optimal use is still under testing.
Cellular treatments with CAR-T as well as T cell-engaging therapies have proven to be highly active in heavily pretreated relapsed myeloma. More data regarding long-term efficacy and adverse event management with the use of immune-based therapies is currently being generated. Next-generation cellular and engineered monoclonal antibody therapies are also under testing and development.”
triple class refractory myeloma triple class refractory myeloma