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.
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What is “Relapse” for Myeloma?
What is a relapse for myeloma patients? What is progressive disease? What is a RR/MM aka relapsed/refractor for myeloma patients and survivors?
Scanxiety- regular blood, urine and imaging diagnostic testing, is a sort of mind-body side effect of living with MM. But that difficulty is minimized when your diagnostic information is good- meaning your MM is in remission. But what does it mean if a diagnostic test changes?
While researching and writing this post I realized that I did not really understand the complete meaning or definitions of what relapse is for multiple myeloma patients.
What is progressive disease? Is it the same as relapse?
The three main issues that solidified in my thinking as a long-term MM survivor are:
- Specific diagnostic values below, for starting or pausing therapy- pause for side effects, re-start for relapsing MM-
- The importance of maximizing the length and depth of the first remission- consider pre-habilitation and/or integrative therapies-
- The cure vs. control debate in MM therapy-
Email me at David.PeopleBeatingCancer@gmail.com if you have questions about your MM-
Hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Relapsed and Refractory Multiple Myeloma
Multiple myeloma is an incurable hematological malignancy, but recent advances in the treatment have improved the survival outcomes in patients. Despite treatment, multiple myeloma patients are at high risk of relapse and need prompt treatment to reduce the morbidity and mortality associated with the disease and its complications.
Patients who fail to achieve at least minimal response on initial therapy and progress while on treatment are termed “primary refractory.”
Multiple myeloma is considered “double refractory” if the disease has progressed during or after treatment with a protease inhibitor and an immunomodulatory agent.
If the patient is also resistant to adding monoclonal antibodies, it is considered a “triple-class” refractory disease, which confers a poor prognosis.
This activity outlines the evaluation and management of relapsed and refractory multiple myeloma and highlights the role of the healthcare teams in improving care for patients with this condition…
According to the criteria developed by the International Myeloma Working Group (IMWG), relapsed refractory MM (RRMM) is defined as a progressive disease, poor response despite treatment, progression within 60 days of the most recent treatment in a patient who had achieved remission, the absence of at least minimal response (MR), or primary refractory MM.[1][2]
IMWG defines progressive disease as at least a 25% increase in serum or urine paraprotein from nadir, or elevations in the monoclonal protein of free light chains (FLC) or the appearance of any of the CRAB feature even in the absence of biochemical progression.[3][4]…
According to an analysis carried out at an institution in 2016, the outcomes for 511 multiple myeloma patients treated with novel therapies between 2006 and 2014 showed a total of 82 patients (16%) developed early relapse within 8 months of initiation of the treatment vs 429 patients ( 84%) who either relapsed after a year or had a continued response to therapy for the duration of the study.
The median overall survival rate was worse in these patients than in those with late relapse. Median overall survival in patients who received autologous stem cell transplantation and relapsed within 12 months was 23.1 months, compared to 122.2 months in the remaining patients indicating early relapse as a poor prognostic factor.[12]
With each subsequent line of therapy and the successive relapse, the response rate decreases along with a shorter time interval to progression. The proportion of patients achieving complete response decreased from 32% at the first-line to 2% at the fifth-line treatment.[13]…
International Myeloma Work Group recommends initiation/modification of treatment if the following perimeters are met:[4]
Clinical Relapse
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Hypercalcemia (serum calcium ≥11.5mg/dL)
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Decrease in hemoglobin of ≥2g/dL
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Rise in serum creatinine by ≥2 mg/dL due to myeloma
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Hyperviscosity requiring therapeutic intervention (deep venous thrombosis, pulmonary embolism)
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Definite increase ≥50% in the size of existing plasmacytoma or bone lesions
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Development of new soft-tissue plasmacytomas or bone lesions
Biochemical Relapse in Patients Without Clinical Relapse
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Doubling of M-component in 2 consecutive measurements separated by 2 months with the reference value of 5g/L, or
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In 2 consecutive measurements, any of the following increases:
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The absolute levels of serum M protein by ≥10g/L, or
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An increase of urine M protein by ≥500 mg/24 h, or
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An increase of involved serum-free light chain by ≥20 mg/dL or 25% increase (whichever is greater)
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What is a relapse for myeloma What is a relapse for myeloma What is a relapse for myeloma