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.
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Who Decides Myeloma Therapy Plan?
Who decides the myeloma patient’s therapy plan? One of the most powerful aspects of online MM groups is the ability of an MM patient or caregiver to ask a simple question.
“Can anyone expand on why some of you are at higher doses of Revlimid? My dad’s on 15mg, but he’s in remission @ 75.? I’m just a bit befuddled as to why such a high dose if he’s in remission…”
The video posted below is what should happen with the MM patient and oncologist, not always what actually does happen. If the caregiver quoted above got all the info during her dad’s appointments, she would not be asking the online MM group about her dad’s Revlimid dose.
How to Make an Informed Myeloma Treatment Decision
Who decides the myeloma patient’s therapy plan, doses, timing, etc?
According to ChatGPT-
In multiple myeloma care, decisions about what therapy a patient receives, in what dose, and on what schedule are usually made collaboratively, but there are clear roles:
1. Oncologist/Hematologist (Lead Decision-Maker)
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The treating hematologist/oncologist is primarily responsible for designing and prescribing the treatment plan.
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They determine which therapy regimen (e.g., VRd, Dara-VRd, ASCT, CAR-T, bispecifics, maintenance, etc.) is most appropriate, based on:
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Disease stage, cytogenetic risk, and organ function
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Patient age, comorbidities, frailty status
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Prior treatments and response history
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Guidelines (e.g., NCCN, ESMO, ASCO) and clinical trial evidence
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2. Multidisciplinary Team (MDT)
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Depending on the center, a myeloma patient’s care may be discussed in tumor boards or MDT meetings, which include:
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Oncologists/hematologists
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Transplant specialists
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Radiologists
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Pathologists
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Pharmacists
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Nephrologists or cardiologists (if kidney/heart issues are present)
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3. Pharmacists & Nurses
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Pharmacists ensure safe drug dosing (renal/hepatic adjustment, drug–drug interactions, supportive meds).
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Nurses handle treatment administration, monitoring, and patient education.
4. Patient’s Role
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The patient makes the final decision to accept or refuse therapy after being informed of:
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Benefits (remission chance, survival benefit)
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Risks (toxicities, quality-of-life impact)
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Alternatives (other regimens, clinical trials, supportive care only)
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Patient preference (e.g., avoiding aggressive transplant, choosing oral vs infusion, prioritizing quality vs quantity of life) can significantly shape the plan.
5. Institutional & External Factors
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Treatment protocols may follow hospital guidelines, national standards (e.g., NCCN in the U.S.), or clinical trial eligibility.
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Insurance/health system approval can influence access to novel therapies (CAR-T, bispecifics).
🔑 In short:
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The oncologist leads the medical decision-making.
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The team ensures safety and feasibility.
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The patient has the right to choose or decline options.
The real takeaway here, in my experience as a MM survivor and MM cancer coach, is that MM patients and caregivers should step up and ask all the questions they may have. Oncology is a business. Your oncologist may be rushed and not take the time needed to explain dosing, timing, etc.
Email me at David.PeopleBeatingCancer@gmail.com with questions about managing your MM.
Hang in there,
David Emerson
- MM Survivor
- MM Cancer Coach
- Director PeopleBeatingCancer
Treatment for Multiple Myeloma
How Do We Create Your Treatment Plan?
Your Fred Hutch hematologist-oncologist works with an entire group of multiple myeloma specialists. They include other hematologist-oncologists, radiation oncologists, pathologists, nephrologists, cardiologists, spine specialists, transplant specialists and researchers who are all looking for better ways to treat this disease.
Every week, this team gathers in a meeting to discuss their patients’ treatment plans. This meeting is called a tumor board. This approach means each patient benefits from the experience of the whole group.
With support from the larger team, your physician will:
- Decide if your disease needs treatment now, or if watchful waiting is best
- Talk about the standard therapies
- Check if any clinical trials match your needs, so you can think about joining them
Your hematologist-oncologist will walk you through the treatment plan that the tumor board has recommended for you. You will have a chance to share your personal preferences and options, and you will decide together what happens next.
Why Do Treatment Plans Differ?
The treatment plan we design for you depends on many things, including:
- If your multiple myeloma is asymptomatic (also called smoldering or indolent) or symptomatic
- If your multiple myeloma is high-risk or standard
- If you have had treatment for multiple myeloma in the past
- Your age and overall health
- Your needs and preferences, like what type of treatment schedule works in your life and if you want to join a clinical trial
What is the Standard Therapy for Multiple Myeloma?
Your treatment plan will be individual to you and your unique circumstances, but physicians often use a combination of chemotherapy, blood and marrow transplant, immunotherapy and radiation therapy to treat multiple myeloma.
At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support, like integrative medicine, nutrition counseling and physical therapy.
Our patients can also choose to have promising new multiple myeloma therapies that you can only get through a clinical trial. Many people come to Fred Hutch for access to these studies. Your care team will tell you about studies that might be right for you, so you can think about joining them.
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