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Post Date : Friday June 29 2007

KW, a 67-year old male was diagnosed with advanced multiple myeloma in March 2001. His CT chest scan with contrast revealed multiple rib lesions and osteolytic lesions of the thoracic spine consistent with osseous metastatic disease. There was volume loss with pleural thickening and parenchymal scarring in the lower lung zones. Small pleural plaque was also seen posteriorly on the right. Focal mass within the lung was suspicious for malignancy. An additional mass involving the right lower ribcage appeared to be in the ninth rib. The mass which appeared to be destroying the rib, measured approximately 2 cm in maximum transverse diameter and extended over a segment 6 cm along the axis of the rib cage. His ninth rib as it abuts the manubrium had a lesion of 2.5 cm transverse that extended 5-6 cm within the rib. There were additional lesions from the rib into the lateral aspect of the T3 vertebra and other areas of lucency seen within the thoracic vertebral bodies that were also suspicious for osteolytic metastases. He was admitted into the hospital March 24, 2001 for diagnostic testing and was found to have a markedly elevated serum protein (9.9 g/L), reduced serum albumin (2.3 g/dL), very high gamma globulin (7.6 g/dL), and a high sedimentation rate (49 mm/hour), all of which are common with multiple myeloma. Serum protein electrophoresis showed a monoclonal protein band in the gamma region with decreased polyclonal immunoglobulins consistent with multiple myeloma. His monoclonal protein at time of diagnosis was 4 g/dL. A bone scan revealed the left humerus suspicious for a metastatic lesion; several metastases to the skull; suspicion of metastasis to the right femur, with a lesion in the proximal cortex laterally; and suspicion of metastasis to the left femur, with evidence of two small lesions of the proximal one-third of the femoral diaphysis.

KW was offered VAD chemotherapy (vincristine, adriamycin, doxorubicin) and refused. experiencing significant bone pain. He agreed to take The Aredia® (pamidronate) by monthly infusion for his fractures and bone pain. His oncologist informed him he had approximately 90 days to live and suggested that he get his affairs in order, arrange hospice care, and start making funeral arrangements. He agreed to take thalidomide/dexamethasone (Thal/Dex) as his treatment. As of July 9, 2001, there had been no positive change in his condition, as evaluated by his oncologist. He still refused VAD. He started a loading dose of Poly-MVA (8 tsp daily) on July 9th, and continued on this loading dose for five months. At this same time he also started taking thalidomide 250 mg per day. After two days, he discontinued thalidomide due to side effects of a rash, circulatory disturbances, and severe muscle and bone pain. After several weeks he tried a lower dose of 50-100 mg of thalidomide per day as tolerated plus a small dose of dexamethasone, three 4-mg tablets per day (the therapeutic dose is 10 4-mg tablets per day). He continued his low, unconventional dose of Thal/Dex and also continued taking Poly-MVA. In November 2001 he was re-evaluated by his oncologist. His monoclonal protein levels fell below 2 g/dL, and his oncologist told him he was in clinical remission. His oncologist said he had never seen a response this dramatic in a patient with advanced stage 4 multiple myeloma.

In December of 2001, KW lowered the dose of Poly-MVA to a maintenance dose of 2 tsp twice daily while continuing the Thal/Dex. He and his oncologist determined when to take the medications based on the evaluation of his monoclonal protein levels. If they stayed below 2.4 g/dL, he didn’t take either the medication. However, if they went above 2.4 g/dL he resumed the thalidomide 50 mg daily for 7-10 days in the month and the blood test was repeated. If the levels were much greater than 2.4 g/dL, he took up to 100 mg of thalidomide for several of the 7-10 days and added dexamethasone if monoclonal protein levels were trending upward. The Poly-MVA apparently allowed him to reduce the thalidomide and dexamethasone doses to a more tolerable level that could be taken intermittently with virtually no side effects. KW discontinued Poly-MVA for three months from September to November 2001 to determine its effect on his treatment and because he was on vacation. After discontinuation, his monoclonal proteins rose to 5.5-6.0 g/dL from a level below 2.0 g/dL in September 2001. Upon resuming the Poly-MVA at the maintenance dose of 4 teaspoons daily, his monoclonal protein levels substantially decreased to 2.0-2.4 g/dL during the period of December 2001 through May 2003. While KM was on a maintenance dose of 4 tsp daily (rather than the loading dose of 8 teaspoon per day) his monoclonal proteins never returned to the low level of 2.4 g/dL or less. In April of 2004 he began to take the Poly-MVA even less consistently (approximately 1-2 tsp, 2-3 times per week) and his monoclonal protein began to rise even further. His monoclonal protein level did not decrease to the levels observed while on the maintenance or loading dose of Poly-MVA (at or below 2.4 g/dL), despite the fact that he was taking thalidomide (50-100 mg) and dexamethasone (12 mg) once per month for a period of 7-10 days.

During late September 2005, KW resumed a loading dose (8 tsp daily) of Poly-MVA in an attempt to lower his monoclonal protein levels to those obtained in early 2002. However, during this four-week period he had suspended taking his thalidomide and dexamethasone completely. His monoclonal protein level rose substantially to 7 g/dL by November of 2005. His laboratory results revealed marked erythrocyte hemolysis, indicative of end-state multiple myeloma. He felt extremely sick and his concerned oncologist admitted him to the hospital on November 28, 2005. He was hospitalized for two days and was started on the full therapeutic dose of thalidomide (250 mg) and dexamethasone (40 mg). He continued Poly-MVA (8 tsp daily) during his stay in the hospital and was able to tolerate the higher dose of the drugs, which he was unable to do when he was first diagnosed and treated. He was visited by hospice but he insisted on going home. After being released, he continued taking the medications at his unconventional dose of 50-100 mg thalidomide and 12 mg of dexamethasone (10-day regimen) while continuing the Poly-MVA (8 tsp/day). By January 2006 his monoclonal proteins plummeted to 2.3 g/dL. This seems to substantiate the synergistic relationship of this integrative treatment approach. He has continued on the loading dose of Poly-MVA and his specific regimen of thalidomide and dexamethasone per the results of monoclonal protein analysis. When his monoclonal proteins rise (he tests them each month) he adds 50-100 mg of thalidomide and 12 mg of dexamethasone for 7-10 days. During his January 2006 visit with his oncologist he exclaimed that he felt “terrific” and had virtually no pain; he still continues his monthly Aredia treatments. KW’s oncologist completely supports the integrative approach he has chosen to take and is delighted at his patient’s remarkable recovery. Table 1 below reflects KW’s total protein, albumin, and gamma globulin levels over the course of his five years of treatment.

Since being diagnosed with stage 4 advanced multiple myeloma approximately six years ago, the patient has changed to a predominantly organic diet, removed all mercury fillings, removed two root canals, and avoids the use of toxic products in or around the house (e.g., cleaning fluid, pesticides, etc.). He remains physically active, travels whenever he chooses, and has an excellent quality of life. As of the submission of this case study, KM still remains in excellent health and his monoclonal proteins are still monitored each month. If they rise slightly above 2.4 g/dL he takes the thalidomide and dexamethasone at his unconventional dose for 7-10 days per month and they quickly go below this number.

After 6 years of surviving stage 4 multiple myeloma, KW passed away. He was switched to revlimid and had a terrible reaction. He was hospitalized due to his reaction to the revlimid twice. He fell and cracked his ribs and became increasingly discouraged so he stopped taking the Poly-MVA as well. His wife expressed gratitude for the excellent quality of life KW has for 6 years after being told he had 3 months to live.

Case study written by Dr. Shari Lieberman as a part of the Poly-MVA Best Case Series.