Hi!
I have IgA lambda MGUS and was recently diagnosed with psoriatic arthritis. My rheumatologist wants to start me on Humira (adalimumab) injections, but in the fine print it says that some people who have been on it have been diagnosed with types of blood cancer.
Does anyone on here have experience with this or know of an alternative drug to take?
I don't want this to cause me to progress.
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6 posts
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MeganLaura - Who do you know with myeloma?: Myself
- When were you/they diagnosed?: MGUS June 2016
- Age at diagnosis: 29
Re: Humira and risk of progression to myeloma
You might want to read through this article:
Mielke, F., and Schweigert, M., "Safe adalimumab therapy for rheumatoid arthritis in a patient with pre-existing multiple myeloma," Nature Clinical Practice Rheumatology, Feb 2008 (full text of article)
Here's a key part of the article:
"No deterioration of the multiple myeloma was detected in this patient despite treatment with adalimumab, which clearly provided relief from symptoms of RA. This observation is in line with several reports. Askling et al. concluded that treatment with TNF antagonists was not associated with increased lymphoma risk in patients with RA. Similarly, Setoguchi et al. found no clinically-relevant increase of cancer risk in patients treated with biologics (etanercept, infliximab, adalimumab, or anakrina) compared with patients treated with standard disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate. Baecklund et al. showed that the increased lymphoma risk observed in patients with RA is associated with inflammatory activity, rather than treatments.
It has to be considered that patients with multiple myeloma could benefit from anti-TNF therapy. Jourdan et al. demonstrated that TNF is a survival factor for myeloma cell lines, inducing their cell cycle and promoting their long-term growth. Because excess TNF is produced in patients with multiple myeloma, and since this is associated with a poor prognosis, these results suggest that anti-TNF therapy might be beneficial for patients with this disease.
On the basis of all available data, the question of whether anti-TNF therapy can be initiated in individuals with previous malignancies is still not solved and requires careful consideration. In the current patient, treatment with adalimumab was shown to be safe despite the presence of a malignancy, suggesting that there is no direct association between treatment with TNF blockers and occurrence of multiple myeloma. If adalimumab had triggered the change from a pre-malignant form to the plasmacytoma, we would have expected further deteriorations due to the continuous anti-TNF therapy. In contrast, we observed a positive outcome, both with respect to the signs of RA and the concomitant parameters.
If patients are provided with close supervision, treatment of RA with TNF antagonists such as adalimumab might be safe and effective in patients with certain malignancies. Furthermore, for patients with severe RA-related complaints, the beneficial effect of anti-TNF treatment might outweigh the slightly increased risk of developing malignancy. More detailed knowledge might be acquired in a systematic clinical study on this subject."
Mielke, F., and Schweigert, M., "Safe adalimumab therapy for rheumatoid arthritis in a patient with pre-existing multiple myeloma," Nature Clinical Practice Rheumatology, Feb 2008 (full text of article)
Here's a key part of the article:
"No deterioration of the multiple myeloma was detected in this patient despite treatment with adalimumab, which clearly provided relief from symptoms of RA. This observation is in line with several reports. Askling et al. concluded that treatment with TNF antagonists was not associated with increased lymphoma risk in patients with RA. Similarly, Setoguchi et al. found no clinically-relevant increase of cancer risk in patients treated with biologics (etanercept, infliximab, adalimumab, or anakrina) compared with patients treated with standard disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate. Baecklund et al. showed that the increased lymphoma risk observed in patients with RA is associated with inflammatory activity, rather than treatments.
It has to be considered that patients with multiple myeloma could benefit from anti-TNF therapy. Jourdan et al. demonstrated that TNF is a survival factor for myeloma cell lines, inducing their cell cycle and promoting their long-term growth. Because excess TNF is produced in patients with multiple myeloma, and since this is associated with a poor prognosis, these results suggest that anti-TNF therapy might be beneficial for patients with this disease.
On the basis of all available data, the question of whether anti-TNF therapy can be initiated in individuals with previous malignancies is still not solved and requires careful consideration. In the current patient, treatment with adalimumab was shown to be safe despite the presence of a malignancy, suggesting that there is no direct association between treatment with TNF blockers and occurrence of multiple myeloma. If adalimumab had triggered the change from a pre-malignant form to the plasmacytoma, we would have expected further deteriorations due to the continuous anti-TNF therapy. In contrast, we observed a positive outcome, both with respect to the signs of RA and the concomitant parameters.
If patients are provided with close supervision, treatment of RA with TNF antagonists such as adalimumab might be safe and effective in patients with certain malignancies. Furthermore, for patients with severe RA-related complaints, the beneficial effect of anti-TNF treatment might outweigh the slightly increased risk of developing malignancy. More detailed knowledge might be acquired in a systematic clinical study on this subject."
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Humira and risk of progression to myeloma
Thank you Multibilly!
I think I'm going to try it. I've talked with my doctors and they've all more or less said that there isn't evidence that it could cause my MGUS to progress, which is good, and I'm being monitored every 3 months for the MGUS, so I'll be able to see if it's having a negative effect on my numbers and can stop it.
It's hard to make decisions like this, but It's nice to have this site to get feedback.
I think I'm going to try it. I've talked with my doctors and they've all more or less said that there isn't evidence that it could cause my MGUS to progress, which is good, and I'm being monitored every 3 months for the MGUS, so I'll be able to see if it's having a negative effect on my numbers and can stop it.
It's hard to make decisions like this, but It's nice to have this site to get feedback.
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MeganLaura - Who do you know with myeloma?: Myself
- When were you/they diagnosed?: MGUS June 2016
- Age at diagnosis: 29
Re: Humira and risk of progression to myeloma
I've had light chain MGUS since 2013 with unstable (ups and downs) M-spikes. I started Humira (adalimumab) about 1.5 years after diagnosis and it actually not only lowered my M-spike levels but stabilized them as well. Since there's no research that it can have this effect, my hematologist was very intrigued. However, after almost 2 years of treatment with Humira, I had to discontinue due to side effects, and strangely since coming off the Humira, my levels have doubled. My hematologist is not sure if this is a fluke coincidence or not, but will know better in 6 months when I get retested after being off Humira for a year to see if levels remain high or not.
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Rosiegeorge
Re: Humira and risk of progression to myeloma
Thanks for sharing your experience, Rosie.
Did the Humira have any effect on your free light chain results, especially your kappa-lambda ratio?
I ask because you say that you have light-chain MGUS. Thus, your M-spike must usually be close to zero, or actually zero. At that level, fluctuations in the M-spike will be essentially just measurement error.
That's why it would be interesting to know what the effect on your free light chains was, since those results are the best for tracking your form of MGUS.
Did the Humira have any effect on your free light chain results, especially your kappa-lambda ratio?
I ask because you say that you have light-chain MGUS. Thus, your M-spike must usually be close to zero, or actually zero. At that level, fluctuations in the M-spike will be essentially just measurement error.
That's why it would be interesting to know what the effect on your free light chains was, since those results are the best for tracking your form of MGUS.
Re: Humira and risk of progression to myeloma
Update:
I’m still taking Humira, although I’ve switched from twice a month to weekly injections based on my arthritis, but my M-spike has gone down to not being detectable and my other numbers are within the normal range, so my oncologist (who denied the link at first) has said he believes that the Humira has actually helped my MGUS. He hypothesizes that my immune system in overdrive caused it to take off, and this has put it in check, to put it simply.
I wanted to share my positive experience. Also, I’ve changed nothing else about my health, diet, or routines other than the injections. I wanted to share my experience even though this disease differs widely between all of us, in case someone was on the fence about starting this like I was.
I’m still taking Humira, although I’ve switched from twice a month to weekly injections based on my arthritis, but my M-spike has gone down to not being detectable and my other numbers are within the normal range, so my oncologist (who denied the link at first) has said he believes that the Humira has actually helped my MGUS. He hypothesizes that my immune system in overdrive caused it to take off, and this has put it in check, to put it simply.
I wanted to share my positive experience. Also, I’ve changed nothing else about my health, diet, or routines other than the injections. I wanted to share my experience even though this disease differs widely between all of us, in case someone was on the fence about starting this like I was.
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MeganLaura - Who do you know with myeloma?: Myself
- When were you/they diagnosed?: MGUS June 2016
- Age at diagnosis: 29
6 posts
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