The recent discussion about the new, non-live shingles vaccine reminded me of something I thought I'd share with the forum. My sister is a nurse and lives in Indianapolis. One of her co-workers' husband has multiple myeloma and had an autologous stem cell transplant about 8 years ago. Within a short period following the procedure, he developed a very bad case of shingles that became life threatening because his immune system was still extremely weak. He was hospitalized and was in ICU. The odd thing is that he recovered from the shingles and as a side benefit is he appears cured of multiple myeloma. He has been free from any measurable myeloma for 8 years.
I recall that there was a clinical trial where people were injected with I believe chicken pox and at least one patient had a complete response and has been myeloma free ever since. Others however did not get any benefit or at least any lasting benefit.
There appears to be something that in some people triggers an immune response that kills the multiple myeloma triggered by the shingles or chicken pox. Have not heard much about this recently.
Forums
7 posts
• Page 1 of 1
-
Ron Harvot - Name: Ron Harvot
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: Feb 2009
- Age at diagnosis: 56
Re: Potential curative effect of severe infection in myeloma
Interesting observation Ron.
See this article:
Kamber, C, et al, "Varicella zoster virus reactivation after autologous SCT is a frequent event and associated with favorable outcome in myeloma patients," Bone Marrow Transplantation, Jan 2015 (full text of article)
You may also recall the engineered measles virus therapy that was being developed by the Mayo that had mixed results. My understanding is that the Mayo is still working on this approach, but is now only targeting patients that have few or no measles antibodies present in their system.
"Phase 2 of Mayo measles trial - informal initial results" (Mar 2, 2015)
No choice ever seems to be simple when it comes to myeloma.
See this article:
Kamber, C, et al, "Varicella zoster virus reactivation after autologous SCT is a frequent event and associated with favorable outcome in myeloma patients," Bone Marrow Transplantation, Jan 2015 (full text of article)
You may also recall the engineered measles virus therapy that was being developed by the Mayo that had mixed results. My understanding is that the Mayo is still working on this approach, but is now only targeting patients that have few or no measles antibodies present in their system.
"Phase 2 of Mayo measles trial - informal initial results" (Mar 2, 2015)
No choice ever seems to be simple when it comes to myeloma.
-
Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Potential curative effect of severe infection in myeloma
Interesting journal article, Multibilly. Thanks for pointing it out. And thanks, Ron, for sharing the story that started this thread.
It seems to me that there could be two reasons for the correlation observed in the journal article between getting herpes post transplant and improved survival.
The first explanation is that getting herpes has some sort of therapeutic effect. Either the virus acts against myeloma, or it stimulates an immune response that acts against multiple myeloma.
The second explanation is that getting herpes is a reflection of a deep response to treatment. Treatment that generates a deep response, particularly when the treatment is high-dose melphalan, may be associated with deeper suppression of the immune system, making it more likely for shingles to occur. Of course, a deeper response to treatment also is usually a sign of more treatment-responsive disease, and thus better survival.
From what I saw, I'm not sure the journal article really provides enough data to sort out which of these explanations best reflects what really is going on in the patients who were part of the study. I'm also not sure how easy it would be, from a statistical perspective, to sort out which of the explanations is correct.
It seems to me that there could be two reasons for the correlation observed in the journal article between getting herpes post transplant and improved survival.
The first explanation is that getting herpes has some sort of therapeutic effect. Either the virus acts against myeloma, or it stimulates an immune response that acts against multiple myeloma.
The second explanation is that getting herpes is a reflection of a deep response to treatment. Treatment that generates a deep response, particularly when the treatment is high-dose melphalan, may be associated with deeper suppression of the immune system, making it more likely for shingles to occur. Of course, a deeper response to treatment also is usually a sign of more treatment-responsive disease, and thus better survival.
From what I saw, I'm not sure the journal article really provides enough data to sort out which of these explanations best reflects what really is going on in the patients who were part of the study. I'm also not sure how easy it would be, from a statistical perspective, to sort out which of the explanations is correct.
Re: Potential curative effect of severe infection in myeloma
One other quick note related to the study Multibilly cited: Apparently, the study's results and conclusion may be statistically flawed. There was a comment on the study by researchers who believe the original study suffers from what is known as "immortal time bias". suffer from what is known as "immortal time bias" The authors of the comment:
"In a recent study Kamber et al. evaluated the prognostic significance of herpes zoster (HZ) in 191 consecutive myeloma patients treated with high-dose melphalan chemotherapy followed by autologous stem cell transplantation (ASCT). The study provides interesting and important data on the burden of HZ in this patient population. However, immortal person-time bias likely affected the methods used to estimate the effect of HZ on survival after ASCT, leading to the spurious appearance of a protective effect."
It's a bit hard to explain what immortal time bias is, so I'll just mention here that there has been criticism of the conclusions to this study, and, as far as I can tell, the authors of the original study have not responded to the criticism.
I still think, however, that this is an interesting subject!
Here's a link to the comment on the article Multibilly cited:
https://www.nature.com/bmt/journal/v50/n6/full/bmt201566a.html
"In a recent study Kamber et al. evaluated the prognostic significance of herpes zoster (HZ) in 191 consecutive myeloma patients treated with high-dose melphalan chemotherapy followed by autologous stem cell transplantation (ASCT). The study provides interesting and important data on the burden of HZ in this patient population. However, immortal person-time bias likely affected the methods used to estimate the effect of HZ on survival after ASCT, leading to the spurious appearance of a protective effect."
It's a bit hard to explain what immortal time bias is, so I'll just mention here that there has been criticism of the conclusions to this study, and, as far as I can tell, the authors of the original study have not responded to the criticism.
I still think, however, that this is an interesting subject!
Here's a link to the comment on the article Multibilly cited:
https://www.nature.com/bmt/journal/v50/n6/full/bmt201566a.html
Re: Potential curative effect of severe infection in myeloma
Thanks for the link about 'immortal time bias', Cheryl. A study participant must have survived long enough past their initial diagnosis to be included in a study, so that precludes anyone who was so ill at the time of the diagnosis that they did not survive long. At least I think that is what is meant. On the reverse side of that, survival rates for any patients who did survive the initial time of diagnosis, would have a longer expected prognosis than the whole group of myeloma patients.
-
Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Potential curative effect of severe infection in myeloma
On a somewhat related note, my husband survived sepsis earlier this spring. He had his first 2 infusions of Kyprolis, became septic, and was in the intensive care unit for two weeks. His M-spike plummeted during this time, more than I might expect from just two Kyprolis infusions. I have wondered whether the overwhelming immune / inflammatory response of sepsis might also have played a role in beating the myeloma back so significantly in such a short time (M-spike went from 1.17 to 0.16 mg/dL, 11.7 to 1.6 g/L).
-
lwem - Name: Laurie
- Who do you know with myeloma?: husband
- When were you/they diagnosed?: April 2015
- Age at diagnosis: 68
Re: Potential curative effect of severe infection in myeloma
Some viruses can apparently directly attack myeloma cells, and can also recruit the body's own immune responses against myeloma. Multibilly posted in a separate forum thread about research investigating using the myxoma virus, which is used in Australia to control the rabbit population (!), to fight myeloma. So it's possible that on occasion, recruiting the body's defenses to fight other viruses (chickenpox reactivation etc) could make the body attack myeloma as well.
7 posts
• Page 1 of 1
Return to Treatments & Side Effects