I am in my 7th round of novel therapy (Velcade, Revlimid and dex) with a stem cell transplant scheduled in late July if the myeloma is under 10% per the bone marrow biopsy. I am a 59 year old woman with a wonderfully supportive family living in Los Angeles. I am taking vitamin D, Astragulus, vitamin C and some B.
I don't want to interfere with the potency of the chemo, but what are the vital supplements to shore up the immune system during this phase?
I am starting to feel very tired and the back pain is bad on most days. I wear a 12.5 fentanyl patch continuously and lidocaine patches on some areas as well.
Thank you for the information on alternative treatment.
Moderator's Note: Joan's question was originally posted in the discussion in the link above, but was split off since it might make a useful topic of its own.
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Re: Supplements to improve immune system during chemo?
Hi Joan,
My doctor recommended that I use a probiotic after my allo transplant. Probiotics may help immune function. I have not had any serious infections for the 3 years since my allo so it seems to be helping me.
"Probiotics can enhance nonspecific cellular immune response characterized by activation of macrophages, natural killer (NK) cells, antigen-specific cytotoxic T-lymphocytes, and the release of various cytokines in strain-specific and dose-dependent manner. Mixture and type (gram-positive and gram-negative) of probiotic organisms may induce different cytokine responses. "
http://www.ncbi.nlm.nih.gov/pubmed/24499072
This abstract also mentions zinc and selenium.
"The review gives data on prospects for using agents based on probiotics and trace elements for immunomodulation. It presents information on that a Lactobacillus casei rhamnosus 35-based probiotic is able to reduce the incidence and severity of viral and bacterial infections. The potential of zinc and selenium as immunotropic agents is shown."
http://www.ncbi.nlm.nih.gov/pubmed/24772516
This abstract mentions aspirin and bisphosphonates. They are not supplements but could be something to discuss with your doctor. Many myeloma patients are already on bisphosphonates. At this point the plan is for me to be on zoledronic acid (Zometa) quarterly for an indefinite period since I had extensive bone damage at diagnosis and my entire treatment strategy is built upon my donor immune system functioning optimally.
"There is growing evidence that many of the most promising cancer chemoprevention agents including aspirin, COX-2 inhibitors, aromatase inhibitors, and bisphosphonates mediate their effects, in part, by enhancing immunosurveillance and reversing the immune evasive mechanisms that premalignant lesions use. In the following review, we introduce critical components of the human immune surveillance system-dendritic cells, T cells, and immune suppressive cells-and discuss the emerging data suggesting that common chemoprevention agents may modulate the function of these immunologic cells."
http://www.ncbi.nlm.nih.gov/pubmed/23918793
Mark
My doctor recommended that I use a probiotic after my allo transplant. Probiotics may help immune function. I have not had any serious infections for the 3 years since my allo so it seems to be helping me.
"Probiotics can enhance nonspecific cellular immune response characterized by activation of macrophages, natural killer (NK) cells, antigen-specific cytotoxic T-lymphocytes, and the release of various cytokines in strain-specific and dose-dependent manner. Mixture and type (gram-positive and gram-negative) of probiotic organisms may induce different cytokine responses. "
http://www.ncbi.nlm.nih.gov/pubmed/24499072
This abstract also mentions zinc and selenium.
"The review gives data on prospects for using agents based on probiotics and trace elements for immunomodulation. It presents information on that a Lactobacillus casei rhamnosus 35-based probiotic is able to reduce the incidence and severity of viral and bacterial infections. The potential of zinc and selenium as immunotropic agents is shown."
http://www.ncbi.nlm.nih.gov/pubmed/24772516
This abstract mentions aspirin and bisphosphonates. They are not supplements but could be something to discuss with your doctor. Many myeloma patients are already on bisphosphonates. At this point the plan is for me to be on zoledronic acid (Zometa) quarterly for an indefinite period since I had extensive bone damage at diagnosis and my entire treatment strategy is built upon my donor immune system functioning optimally.
"There is growing evidence that many of the most promising cancer chemoprevention agents including aspirin, COX-2 inhibitors, aromatase inhibitors, and bisphosphonates mediate their effects, in part, by enhancing immunosurveillance and reversing the immune evasive mechanisms that premalignant lesions use. In the following review, we introduce critical components of the human immune surveillance system-dendritic cells, T cells, and immune suppressive cells-and discuss the emerging data suggesting that common chemoprevention agents may modulate the function of these immunologic cells."
http://www.ncbi.nlm.nih.gov/pubmed/23918793
Mark
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Mark
Re: Supplements to improve immune system during chemo?
Joan,
I remember reading about not taking vitamin C on your Velcade days. I stopped taking it when I was getting my Velcade treatments. There was a Myeloma Beacon article about this from 2009:
Vitamin C Inhibits Anti-Myeloma Activity Of Velcade
Here's related information on the National Cancer Institute website:
http://www.cancer.gov/cancertopics/pdq/cam/highdosevitaminc/healthprofessional/page6
I remember reading about not taking vitamin C on your Velcade days. I stopped taking it when I was getting my Velcade treatments. There was a Myeloma Beacon article about this from 2009:
Vitamin C Inhibits Anti-Myeloma Activity Of Velcade
Here's related information on the National Cancer Institute website:
http://www.cancer.gov/cancertopics/pdq/cam/highdosevitaminc/healthprofessional/page6
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DallasGG - Name: Kent
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: 6/20/2013
- Age at diagnosis: 56
Re: Supplements to improve immune system during chemo?
Hi Joan,
Unfortunately, there is so much conflicting information about taking supplements during chemo. There is concern about possible interactions with the chemo drugs. Pretty much fear of the unknown if you will. Due to the limited knowledge, some oncologists will recommend not taking any supplements.
I personally agree you need to try to do all you can to strengthen & improve your immune system. I would suggest voicing your concerns to your oncologist and perhaps seeking the advice of a nutritionist. If you have access to an intergrative oncologist, they should be able to advise you concerning supplements as well.
My loved one recently finished his 4th round of chemo (Velcade, Revlimid & Dex) and has begun taking a probiotic. We felt this would be helpful in strengthening his immune system after all the chemotherapy. Probiotics are helpful because 70% of your immune cells are in the gastrointestinal system.
Speak to your oncologist, he/she should be able to address your questions.
All the best to you,
Kim
Unfortunately, there is so much conflicting information about taking supplements during chemo. There is concern about possible interactions with the chemo drugs. Pretty much fear of the unknown if you will. Due to the limited knowledge, some oncologists will recommend not taking any supplements.
I personally agree you need to try to do all you can to strengthen & improve your immune system. I would suggest voicing your concerns to your oncologist and perhaps seeking the advice of a nutritionist. If you have access to an intergrative oncologist, they should be able to advise you concerning supplements as well.
My loved one recently finished his 4th round of chemo (Velcade, Revlimid & Dex) and has begun taking a probiotic. We felt this would be helpful in strengthening his immune system after all the chemotherapy. Probiotics are helpful because 70% of your immune cells are in the gastrointestinal system.
Speak to your oncologist, he/she should be able to address your questions.
All the best to you,
Kim
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Jerseygyrl - Name: Kim
- Who do you know with myeloma?: My Loved One
- When were you/they diagnosed?: February 2014
- Age at diagnosis: 58
Re: Supplements to improve immune system during chemo?
These are questions I always have when it comes to taking supplements:
Is there reliable data to show that the supplements work? If it does, in what way does it boost the immune system? Myeloma cells are cells of the immune system that have subverted growth and/or survival pathways. When you take a supplement to boost, are you boosting anti-myeloma responses, or are you boosting pro-myeloma immune functions?
To me, the best "supplement" that one could do during chemotherapy, or at any time actually, is to partake in activities that will minimize your stress. I think that would have a very positive effect on the immune system, and without concern of adverse effects.
Is there reliable data to show that the supplements work? If it does, in what way does it boost the immune system? Myeloma cells are cells of the immune system that have subverted growth and/or survival pathways. When you take a supplement to boost, are you boosting anti-myeloma responses, or are you boosting pro-myeloma immune functions?
To me, the best "supplement" that one could do during chemotherapy, or at any time actually, is to partake in activities that will minimize your stress. I think that would have a very positive effect on the immune system, and without concern of adverse effects.
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dnalex - Name: Alex N.
- Who do you know with myeloma?: mother
- When were you/they diagnosed?: 2007
- Age at diagnosis: 56
Re: Supplements to improve immune system during chemo?
Hi AlexN,
I hope you are doing well today. Great points about myeloma basically being cancer of the immune system. I always go out of my way to mention that I did an allo so things that apply to me may not apply to others. Patients need to realize that their own immune systems cannot identify the cancer cells as foreign so just "stimulating" your own immune system is not necessarily a good thing for some of the reasons you mention.
As an FYI you will find numerous studies discussing the immune modulating effects of vitamin D.
"Immunomodulatory responses to the active form of vitamin D (1,25-dihydroxyvitamin D, 1,25D) have been recognized for many years, but it is only in the last 5 years that the potential role of this in normal human immune function has been recognized. Genome-wide analyses have played a pivotal role in redefining our perspective on vitamin D and immunity. The description of increased vitamin D receptor (VDR) and 1α-hydroxylase (CYP27B1) expression in macrophages following a pathogen challenge, has underlined the importance of intracrine vitamin D as key mediator of innate immune function. It is now clear that both macrophages and dendritic cells (DCs) are able to respond to 25-hydroxyvitamin D (25D), the major circulating vitamin D metabolite, thereby providing a link between the function of these cells and the variations in vitamin D status common to many humans. The identification of hundreds of primary 1,25D target genes in immune cells has also provided new insight into the role of vitamin D in the adaptive immune system, such as the modulation of antigen-presentation and T cells proliferation and phenotype, with the over-arching effects being to suppress inflammation and promote immune tolerance. In macrophages 1,25D promotes antimicrobial responses through the induction of antibacterial proteins, and stimulation of autophagy and autophagosome activity. In this way variations in 25D levels have the potential to influence both innate and adaptive immune responses. More recent genome-wide analyses have highlighted how cytokine signaling pathways can influence the intracrine vitamin D system and either enhance or abrogate responses to 25D. The current review will discuss the impact of intracrine vitamin D metabolism on both innate and adaptive immunity, whilst introducing the concept of disease-specific corruption of vitamin D metabolism and how this may alter the requirements for vitamin D in maintaining a healthy immune system in humans."
http://www.ncbi.nlm.nih.gov/pubmed/24795646
Not that this what the OP is asking, but there are also studies on allo transplant recipients that link vitamin D deficiency to GVHD. My doctor suggested I take vitamin D after my allo. There are also trials listed that are studying probiotics for allo transplant recipients as well.
"Vitamin D, a hormone involved in bone and calcium homeostasis, has been shown to have potent immunomodulatory effects. We performed a retrospective cohort analysis to evaluate whether monohydroxyvitamin D levels before allogeneic hematopoietic SCT (HSCT) correlate with the risk of GVHD. Fifty-three patients who underwent myeloablative HSCT were studied. Vitamin D levels were measured in serum samples obtained before HSCT. The median 25-hydroxyvitamin vitamin D level was 21.9 ng/mL (7.8-45.7). The cumulative incidence (CI) of grades II-IV acute GVHD at 100 days was 53.1% in patients with vitamin D<25, versus 33.3% in patients with vitamin D ≥ 25 ng/mL (P=0.13). The CI of chronic GVHD (cGVHD) at 2 years in patients with vitamin D<25 was 63.8%, compared with 23.8% in patients with vitamin D ≥ 25 ng/mL (P=0.009). Similarly, the 2 year CI of extensive cGVHD was significantly greater in patients with vitamin D<25 compared with those with vitamin D ≥ 25 ng/mL (54.5% versus 14.3%, P=0.005). In a multivariable competing risk model, low pre-transplant vitamin D levels remained a significant factor associated with cGVHD (hazard ratio=5.26, P=0.02). Our results demonstrate that vitamin D deficiency before HSCT is associated with an increased risk of cGVHD."
http://www.ncbi.nlm.nih.gov/pubmed/23000654
Again, a patient should ask their doctor if a supplement is right for them.
Mark
I hope you are doing well today. Great points about myeloma basically being cancer of the immune system. I always go out of my way to mention that I did an allo so things that apply to me may not apply to others. Patients need to realize that their own immune systems cannot identify the cancer cells as foreign so just "stimulating" your own immune system is not necessarily a good thing for some of the reasons you mention.
As an FYI you will find numerous studies discussing the immune modulating effects of vitamin D.
"Immunomodulatory responses to the active form of vitamin D (1,25-dihydroxyvitamin D, 1,25D) have been recognized for many years, but it is only in the last 5 years that the potential role of this in normal human immune function has been recognized. Genome-wide analyses have played a pivotal role in redefining our perspective on vitamin D and immunity. The description of increased vitamin D receptor (VDR) and 1α-hydroxylase (CYP27B1) expression in macrophages following a pathogen challenge, has underlined the importance of intracrine vitamin D as key mediator of innate immune function. It is now clear that both macrophages and dendritic cells (DCs) are able to respond to 25-hydroxyvitamin D (25D), the major circulating vitamin D metabolite, thereby providing a link between the function of these cells and the variations in vitamin D status common to many humans. The identification of hundreds of primary 1,25D target genes in immune cells has also provided new insight into the role of vitamin D in the adaptive immune system, such as the modulation of antigen-presentation and T cells proliferation and phenotype, with the over-arching effects being to suppress inflammation and promote immune tolerance. In macrophages 1,25D promotes antimicrobial responses through the induction of antibacterial proteins, and stimulation of autophagy and autophagosome activity. In this way variations in 25D levels have the potential to influence both innate and adaptive immune responses. More recent genome-wide analyses have highlighted how cytokine signaling pathways can influence the intracrine vitamin D system and either enhance or abrogate responses to 25D. The current review will discuss the impact of intracrine vitamin D metabolism on both innate and adaptive immunity, whilst introducing the concept of disease-specific corruption of vitamin D metabolism and how this may alter the requirements for vitamin D in maintaining a healthy immune system in humans."
http://www.ncbi.nlm.nih.gov/pubmed/24795646
Not that this what the OP is asking, but there are also studies on allo transplant recipients that link vitamin D deficiency to GVHD. My doctor suggested I take vitamin D after my allo. There are also trials listed that are studying probiotics for allo transplant recipients as well.
"Vitamin D, a hormone involved in bone and calcium homeostasis, has been shown to have potent immunomodulatory effects. We performed a retrospective cohort analysis to evaluate whether monohydroxyvitamin D levels before allogeneic hematopoietic SCT (HSCT) correlate with the risk of GVHD. Fifty-three patients who underwent myeloablative HSCT were studied. Vitamin D levels were measured in serum samples obtained before HSCT. The median 25-hydroxyvitamin vitamin D level was 21.9 ng/mL (7.8-45.7). The cumulative incidence (CI) of grades II-IV acute GVHD at 100 days was 53.1% in patients with vitamin D<25, versus 33.3% in patients with vitamin D ≥ 25 ng/mL (P=0.13). The CI of chronic GVHD (cGVHD) at 2 years in patients with vitamin D<25 was 63.8%, compared with 23.8% in patients with vitamin D ≥ 25 ng/mL (P=0.009). Similarly, the 2 year CI of extensive cGVHD was significantly greater in patients with vitamin D<25 compared with those with vitamin D ≥ 25 ng/mL (54.5% versus 14.3%, P=0.005). In a multivariable competing risk model, low pre-transplant vitamin D levels remained a significant factor associated with cGVHD (hazard ratio=5.26, P=0.02). Our results demonstrate that vitamin D deficiency before HSCT is associated with an increased risk of cGVHD."
http://www.ncbi.nlm.nih.gov/pubmed/23000654
Again, a patient should ask their doctor if a supplement is right for them.
Mark
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Mark
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