Multiple Myeloma - Survival Rate Statistics by Hospital
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How Critical is Supportive Care to Multiple Myeloma Survival?  Does It Improve Life Expectancy and Survival Rates?

11/25/2013

11 Comments

 
In football they often say," The Best Offense is a Good Defense", and Bear Bryant of University of Alabama football fame is noted for his quote, "Offense fills seats, but Defense wins Championships".
Picture
Dick Butkus, A Great Bear of a Defense!
I make this point because I recently had an epiphany when I was thinking about why on earth the National Cancer Institute estimates  22,350 new cases of myeloma for 2013 and just 10,710 deaths. If you look at other cancers the difference in deaths and new cases is a very good estimate of the cure rate for that cancer, but for multiple myeloma this method of estimation would indicate a cure rate of 52%.  I would just love to believe this to be true, but the National Cancer Institute's own data reports long term survival is no more than 10 to 15%.   So what is the difference?

Myeloma patients seldom die from myeloma, they die from the complications from myeloma, and how this is reported might be one reason for this discrepancy.   The number one reason is pneumonia, other infections, kidney failure, anemia, etc.   



This, therefore, brings me to the realization that supportive care for the treatment of the many complications of this disease may just be as important as the cancer treatment itself.  Or a great Defense(supportive care) is as important as the Offense(cancer therapy).   MD Anderson and Mayo Clinic emphasize supportive care in their programs, UAMS actually has a Director of Supportive Care in their myeloma program, and Dr. Elias Anaissie, the Director of the Myeloma Program at the University of Cincinnati Cancer Center, has an extensive background in supportive care.  Dr. Anaissie has published a well written example of an exceptional supportive care model. You can read this publication if you CLICK HERE.  The British have another great publication on supportive care if you CLICK HERE.

I can only speak from my own experience, and that comes from my treatment at UAMS.  They made sure that patients and their caregivers knew of the complications from the disease, and especially during the neutropenic phase of the stem cell transplant when you have NO immune system.   My wife, and caregiver, and I were given instruction in these complications, and  she was  trained on how to give me antibiotics and other drugs through my infusion port.  We were also given instructions on what to do if I had a fever.  In addition,  I was administered an anti fungal, antibiotic, and antiviral as a replacement for my immune system.  Because these myeloma centers of excellence have seen most every eventuality, their supporting care staff has the same extensive experience with the complications from myeloma and its treatment.  Without this experience, locations that do not have a large myeloma population just " Don't Know what they Don't Know"!  This education came in handy when I was running  a fever of 103 from pneumonia, and my wife and daughter forced this "I'M OK MAN" to go to the emergency room, where they were just able to pull me from the jaws of death.   I went septic in just a few hours, and that for a myeloma patient is most often terminal.  It went from, I am tired and need to lay down, to a fever, and the emergency room in just a few hours.

I also wonder why the top myeloma specialists who report their survival rates have a two year death rate of just 3 to 12%, whereas the two year average death rate reported by the National Cancer Institute is 34.4%.  Maybe they "Do Know what they need to Know"!  You are 3 to 11 times more likely to survive 2 years under the care of a skilled myeloma professional, as compared to the average of all facilities reported by the National Cancer Institute.  

For more information on multiple myeloma survival rates and life expectancy,  go to the web site www.myelomasurvival.com, or you can follow me on my twitter account at: https://twitter.com/grpetersen1 



11 Comments
Ed
11/25/2013 11:35:58 am

I also believe continuous degradation of organ function from treatment (maintenance) substantially contributes to demise. I was dx'ed in 3/2011 w/ Lambda Light Chain MM and am treating at UAMS under TT4 protocol. At time of dx, my LLCs were through the roof but my kidneys were apparently handling the excess, to the surprise of my local onco/hemo. Notwithstanding this circumstance and with the absence of the original protein (LLC) based on testing since consolidation, my creatinine clearance has steadily increased (bad) and I believe this is due to maintenance drugs including Velcade, zometa, revlimid and Thalomid.

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Gary Petersen link
11/25/2013 12:29:52 pm

Ed, I think anytime we put chemotherapy drugs into our system it has to have some negative impact. All you have to do is read the insert on any of the drugs we take and the list of potential side effects is extensive. We can only hope that the benefit, a possible cure, is worth the side effects. If the side effects are too significant we can change the drug or reduce the dose. We have other options. You mention that your creatinine clearance has steadily increased, did you mean creatinine level. Because a higher clearance is good, and a higher creatinine level is bad. My creatinine level was 6.4, and is now 1.9 which is better but still not good. If you are low risk, and in CR, and with creatinine less than 1.3, you are in tall cotton. Best Regards/Gary

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Ed
11/25/2013 04:25:35 pm

Yes, sorry, I meant creatinine level. My 1 year older sister was dx'ed w/ MM at age 48 in 2003 and was part of the TT2 protocol trial at UAMS to determine Thal dosage levels. They were not at that time stratifying risk. She passed away in 2006 and I believe died from treatment related issues vs MM.

Gary Petersen link
11/26/2013 01:22:31 am

Ed so sorry for the loss of your sister. She was so young to get MM, and now you. Your family has been through so much. May God Bless your myeloma journey. Gary Petersen

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Gary Petersen link
11/26/2013 04:54:40 am

Ed, you said that you were taking RVd, and because I had kidney damage they would not give me VTD-PACE nor RVd at UAMS. I was given VTD-ACE and VTd, or they replaced the Revlimid with Thalamid because Revlimid can cause kidney issues. Talk to your doctor at UAMS and they can substitute the R for T if the creatinine is or becomes an issue. Best Regards/Gary

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Mark
11/27/2013 08:44:18 am

Hi Gary,

Great article. I do think there is something to what Ed just mentioned. Continuous therapy seems to have a negative effect on patients immune systems long term. I believe you have mentioned that you have a need for IVIG infusions to prevent infection. I had 4 infusions of IVIG after my allo since I basically had no immune system and was taking an immunosuppressive drug (Prograf) to prevent GVHD. Currently my Immunology Panel is all in the normal range and I have the same risk of infection as someone in the general population. In reality it is probably less due to how careful I am to avoid infection. Looking back it is amazing I did not get infections prior to getting myeloma because I did not do anything to avoid infection.

This recent study shows the negative long term impact of Revlimid maintenance on the immune system.

Lenalidomide impaired long-term thymic T-cell reconstitution, decreased CD4+ and CD8+ CD45RA+CCR7- effector-terminal T-cell absolute counts and increased CD4+CD25+CD127-/low regulatory T-cells. Lenalidomide consolidation and long-term maintenance therapy, administered post-ASCT, may have a potentially negative impact on immune surveillance.
http://www.ncbi.nlm.nih.gov/pubmed/24237448

Here is what CD4+ cells do:
CD4+ T helper cells are white blood cells that are an essential part of the human immune system. They are often referred to as CD4 cells, T-helper cells or T4 cells. They are called helper cells because one of their main roles is to send signals to other types of immune cells, including CD8 killer cells. CD4 cells send the signal and CD8 cells destroy and kill the infection or virus. If CD4 cells become depleted, for example in untreated HIV infection, or following immune suppression prior to a transplant, the body is left vulnerable to a wide range of infections that it would otherwise have been able to fight.

It would be nice if the docs mentioned this to their patients when discussing Revlimid maintenance with their patients. It is amazing to me how little the myeloma docs discuss the LONG TERM side effects of the therapies they recommend to their patients.

Mark

Reply
Gary Petersen link
11/27/2013 11:05:05 am

Mark, I do think you and Ed have made an excellent point. The question is when should the drugs be stopped. I had asked after 3 years of VTd, if I should stop but my doctor (not BB at the time) asked why stop if it is working. I went another year and one half and I THINK it may have been better if I had stopped earlier. We are taking very toxic medications, so the proper balance will always be a huge issue. Stop too early and relapse or take it too long and have complications that are permanent. I do feel blessed to be here after 7 years and 9 months with the side effects I do have, which are manageable.

Reply
Mark
11/27/2013 02:16:21 pm

Hi Gary,

First of all Happy Thanksgiving. As 2 patients doing well and on our way to becoming long term survivors we have a LOT to be thankful for.

Obviously I am no doctor and BB knows your case and I am sure he made the best decision for you. I am more looking at it from the perspective of patients today that do not seem to be told of the known side effects of drugs. Use your case as a for instance. Back then I am sure the doctors did not know that IMIDs would have the potential long term side effect of stopping your immune system from making cells it needs to function properly even after you stopped using it. If a patient wants to stay on maintenance knowing that, by all means they should stay on it. It seems to me that the myeloma docs go over the benefits but seem to skip over some key side effects that the patient should know before making a decision on using a certain drug. Maybe it is just me but I never hear the myeloma doctors mention this as a potential side effect of maintenance therapy. Take note of this video. This doctor tells his patients taking Revlimid maintenance should be like taking a vitamin? Are you kidding me?!?!?! Revlimid has some serious side effects and IMO comparing it to taking a vitamin is not something a responsible doctor should be doing. I have a feeling he is not going over all of the potential side effects of long term Revlimid use if he compares it to taking a vitamin.
http://www.youtube.com/watch?v=GgLfHh4Vqqw



Let me use another example. I have seen multiple patients in forums mention that it seems that they have noticed some patients developing diabetes and if that is a known side effect of any myeloma drugs. That is a well known side effect of long term DEX use. Obviously these patients are not being counseled on the potential long term side effects of the drugs they are taking. I am not saying DEX should never be used but at least let the patient know what the common side effects of the drug are.

Mark

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Gary Petersen link
11/28/2013 02:48:20 am

Happy Thanksgiving to everyone! We myeloma patients do have a lot to be thankful for. The new drugs, the dedicated doctors and researchers, the great foundations that support us, the improvements in therapy, and our families and friends. And now we can be thankful for the fact that we live long enough for us to be able to evaluate and debate the long term impart of drugs on our quality of life.

Revlimid is not aspirin, and most all patients find out about the DEMON DEX. I have two new lenses because of cataracts. But through it all I am still here, and am most Thankful for that. Have a Great Holiday/Gary

Reply
Kay
8/21/2017 07:58:17 am

I was diagnosed with multiple myeloma June 2017 and what I'm hearing is people die more from treatment then the myeloma. Would I be better of without treatment and just die from disease.

Reply
Gary Petersen link
8/21/2017 02:11:51 pm

Kay, in rare cases such as if you have smoldering myeloma you would watch and wait. If you have myeloma you without treatment you will live on average 8 to 10 months from diagnosis to death. If you go to a myeloma specialist you if low risk myeloma, you will live for a decade or more. Whoever you are getting this information from is ill informed and you need to find another source.
Treatments are not pleasant, but they have become very safe and effective. If you learn more about this disease from knowledgeable doctors, patient advocates, and patients you will find you have a good change now of CURE! Good Luck and God Bless your families myeloma journey/Gary

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