Integrative Medicine Case Reports, Volume 3, Issue 1 (January), 2022

Impact of integrative therapy in remission of Multiple Myeloma: A case study

Reshma P. Jogdand, Amit Singh, Umashankar Khumbhare, Parameshwar and R. Nagaratna

Department of Life sciences, SVYASA University, Bangalore

Introduction

Multiple myeloma (MM) is an incurable, biologically heterogeneous disease of uncontrolled development of monoclonal plasma cells in the bone marrow that prompts the over­production of nonfunctional unblemished immunoglobulin chains.

The gathering of these immunoglobulin’s and collaboration of the unusual monoclonal plasma cells with different cells in the bone marrow lead to a large group of issues including anemia, bone lesions, infections, hypocalcemia, renal failure, fatigue, and pain (1). Multiple myeloma (MM), also known as plasma cell myeloma and Simple myeloma, a cancerous condition in which plasma cells are involved, in which normally white blood cells produce antibodies (2). Often, there were no symptoms are noticed initially. As it progresses, bone pain, anemia, kidney dysfunction, and infections may occur. Complications may include amyloidosis (3).

Causes and risk factors

The cause of multiple myeloma is unknown (4). Risk factors include obesity, radiation exposure, family history, and certain chemicals (3). World Health Organization grouping framework separates MM from other plasma cell issues like monoclonal gammopathy of dubious importance (MGUS), singular plasmacytoma of the bone, extraosseous plasmacytoma, and monoclonal immunoglobulin affidavit sicknesses (5).

MM is the second most common hematologic malignancy. The American Cancer Society predicts there will be 30,280 new MM analyzed and 12,590 passing identified with the infection in the United States in 2017 (6).

Prevalence

Worldwide, multiple myeloma influenced 488,000 individuals and brought about 101,100 passing in 2012 (7,8). In the United States, it creates in 6.5 per 100,000 individuals each year and 0.7% of individuals are influenced sooner or later in their lives (9). It has been estimated that in 2012, 89,658 people were living with MM (10). The risk of developing MM is higher in older age groups, whereas it is a much more uncommon diagnosis for patients under the age of 4 years 5 (11). The median age at diagnosis is 65 years and the current 5-year survival is approximately 46.6% (10). It usually occurs around the age of 60 and is more common in men than women (2).

Sign and symptoms

Since numerous organs can be influenced by myeloma, the indications and signs vary greatly. Fatigue and bone pain are the most common symptoms at presentation. The CRAB criteria encompass the most common signs of multiple myeloma (12).

• Calcium: serum calcium >0.25 mmol/l (>1 mg/dl) higher than the upper limit of normal or >2.75 mmol/l (>11 mg/dl)

• Renal insufficiency: Creatinine clearance <40 ml per minute or serum creatinine >1.77 mol/l (>2 mg/dl)

• Anemia: hemoglobin value of >2 g/dl below the lowest limit of normal, or a hemoglobin value <10 g/dl

• Bone lesions: one or more osteolytic lesions on skeletal radiography, CT, or PET/CT

Pathogenesis

Multiple myeloma may develop from monoclonal gammopathy of undetermined significance that progresses to smoldering myeloma (13).

Figure 1: Pathogenesis of multiple myeloma

Diagnosis

Multiple myeloma is analyzed dependent on blood or Urine tests discovering unusual antibodies, bone marrow biopsy discovering harmful plasma cells, and clinical imaging discovering bone sores. Another normal finding is high blood calcium levels (2). Multiple myeloma is considered treatable, but generally incurable (3).

Reductions might be achieved with steroids, chemotherapy, directed treatment, and undifferentiated organism relocation. Bisphosphonates and radiation treatment are now and then used to decrease pain from bone injuries (2).

Role of yoga in cancer

A few variables assume a part at the beginning of malignancy. Expanding significance is being given to aggravation. While acute inflammation is healing and beneficial, chronic inflammation has the opposite effect. Chronic inflammation triggers NF-kappa-B (NFkB), the protein complex which influences DNA transcription among other functions. NFkB activates a pathway resulting in the expression of pro-inflammatory genes such as cytokines, adhesions molecules, and other chemicals. At this stage, there is sure proof that yoga and positive changes in one’s way of life can switch this cycle.

Stress and cancer

Stress associated with diagnosis and treatment of cancer affects not only quality of life but leads also to poorer prognosis and shorter survival. Adverse effects of stress on prognosis occur through the following mechanisms:

1. Suppression of natural killer (NK) cells and their cytotoxicity.

2. Poor repair of damaged DNA.

3. Modulation of apoptosis and Oxidative stress: aggravated by psychological stress. NK cell activity increases by relaxation methods. Patients with malignant melanoma (Skin cancer), who underwent a relaxation program for 6 weeks had a significant increase in the percentage of NK cells, as well as an increase in NK cell cytotoxicity, as also lower rates of recurrence and death. Similarly, supportive group relaxation methods led to longer survival and better quality of life among women with advanced breast cancer. Yoga, meditation, and pranayama are centuries-old processes; known to relax the mind and energize the body. SK Yoga, a rhythmic breathing process, introduced by Sri Sri Ravishankar Ji, is known to eliminate stress, anxiety, and depression and increase enthusiasm. Fall in blood lactate, increase in glutathione, superoxide Dismutase (SOD) and catalase, and increase in natural killer (NK) cells indicate relaxation, better antioxidant, and better immune effects of SKY in normal individuals and those with cancer. Further confirmation of better antioxidant defense was available through studies conducted using reverse transcriptase-polymerase chain reaction (RT-PCR), at AIIMS. This was accompanied by better stress regulation and better immune status due to the prolonged life span of lymphocytes by up-regulation of antiapoptotic genes and pro-survival genes. Qu et al observed a rapid and significantly greater effect of SKY on gene expression in peripheral blood mononuclear cells (PBMNs). Other positive effects of SKY included a reduction in tobacco addiction and reduction in side effects of chemotherapy. Hence, SKY appears useful adjunct to cancer management.

Case presentation

A 65 years old male participant, Mrs. XXX enrolled as a participant in Prashanti Kutiram (Arogyadhma) in December 2019, and Intervention (Integrated protocol for Oncology) has been given for about 27 days and the study had been followed up for 1 year.

Yoga therapy protocol (14)

Table 1: Yoga practices

Ayurveda protocol

Table 2: Ayurveda Protocol

Naturopathy protocol

Table 3: Naturoapthy Treatment

Diet plan

Table 4: Diet guidelines

Subjective symptoms

Table 5: Subjective Symptoms

Key parameters reading

Table 6: Follow up key parameters

Vital parameters pre and post reading

Table 7: Pre-post Vital parameters

*In Remission undergoing maintenance medicines during chemotherapy and after chemotherapy:
Pomalidomide: 2 mg: PO: 21/28 daycycle
Asprin: 75 mg: 21/28 daycycle
Zolendronic Acid: 4 mg: IV infusion: Monthly

Figure 2: Pre post changes of parameters in graphical presentation

Positive results of Integrative treatment, in particular, are:

• Medication has been stopped since Feb 2021.

• Pain in the shoulder & lower back is also reduced.

• Deep Vein Thrombosis in the lower limp has been completely resolved.

Key parameters have shown significant improvement towards normalcy.

Discussion

Yoga is a mind-body therapy that includes three components: (1) physical alignment poses (asanas), breathing techniques (pranayamas), and mindful exercises (meditations). Integrated Approach (Yoga, Ayurveda, Naturopathy) is positively effected in Myeloma condition with positive changes in key parameters like SPE (serum protein electrophoresis), Free light chain and PET CT. Deep vein thrombosis is one of the complications of chemotherapy in this case integrative therapy has a proven to reduce signs of the same, complaints with severe scapular pain and mid back pain as well as a participant is relived from fatigue too, Integrative Therapy significantly gives an improvement in day to day activity like performing own work and daily routine, Participant was not depended on any assist activity these give confidence and Courage in Day to day activity, On the physical level, it gives a remarkable improvement, as well as mental health, gets better day by day, Vital parameters are also showing a positive changes and Medication has stopped completly. As part of the Cause, the stress factor plays a vital role in the cancerous condition, Integrative therapy also worked to reduce oxidative stress as well as in Inflammatory markers. Integrative medicine has proven to reduce chemotherapy side effects yoga practice is also positively effective in reducing chemotherapy side effects. Integrative medicine has an impact on all aspects of health like Mental, physical, social as well as spiritual levels.

Conclusion

Integrative therapy was found to be positively affected in remission on condition and symptomatic relives as well as stress condition. Integrative therapy helps to reduce chemotherapy side effect. The treatment helped to maintain a good quality of life if the practice is regular and continuous.

Limitation

It’s a single case study, For future study Randomised control trial with longer sample size is needed and a Mechanism action study to rule of the mode of action of yoga therapy in Multiple Myeloma.

Acknowledgment

First of all, I bestow in front of Lord Dhanavantari and express the deepest gratitude to the almighty. In addition, I would like to acknowledge the following people who played an instrumental role in the completion of this project. I express my appreciation for the blessings of my gurus and salutations to my parents and all my teachers. I am grateful to Dr. Nagarathna and Dr. Amit Singh of research for sharing their thoughts with other people.

Special thanks to a person who motivated me for this work is Dr. Amit Singh, his guidance and support make me more strong and more confident to study in this area. I am appreciative to section therapist Mr. Parameshwar and section In-charge Dr. Umashankar for their guidance and for allowing me to provide Yoga therapy details and their immense support in my presented work. My love and regards go to my loving parents for their endless support and encouragement. I express my gratitude to all the participants, as they were the true inspiration and purpose.

Authorship contribution

Dr. Reshma P. Jogdand has written an article.
Dr. Amit Singh and Dr. Nagarathna R-Treatment protocol making and guided to write an article.
Dr. Umashankar and Mr. Parmeshawar have contributed to a treatment Application and planning.

Informed consent

Yes.

Source of funding

Nil.

Conflict of interest

Nil.

Received Date: 09-01-22; Revised Date: 09-02-22
Accepted Date: 12-02-22

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