Case Report

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





Multiple Myeloma
Stage 3
Bone pain
Lower back pain
Yoga therapy
Quality of life


The present case is of Multiple Myeloma who visited Arogyadhama (SVYASA University, Bangalore) patient’s name is Mr. XXX 65 years old. In March 2019, he was admitted to arogyadhama with a diagnosis of Multiple Myeloma Stage 3 and briefed his medical history as reported to the physician on the first time with a chief complaint of severe pain in the right scapula and mid/lower back. On the advice of the orthopedist, he undertook an MRI of the backbone and a PET CT Scan. Reports revealed lesions in the vertebrae, right scapula, and other skeletal structures. Blood work: CBC, Serum Protein Electrophoresis, Free light chain, Bone marrow, etc showed very high values of Monoclonal Protein, Plasma cells, low Hb, low Albumin, etc. And as per the reports and markers condition was diagnosed as Multiple Myeloma Stage 3. The patient consulted an Oncologist at Cytecare Cancer Hospital, Yelahanka, Bangalore. And treatment commenced for 24 weeks involving Immunotherapy drugs, steroids, bone-strengthening injections, etc. Post this 24 weeks treatment, he was in remission with a maintenance drug. In Dec 2019, he consulted in Arogyadhama and briefed the physician about the diagnosis of Multiple Myeloma and the treatment received. On the physician’s suggestion, the patient enrolled himself for Integrative Therapy at SVYASA and received treatment involving various Yoga, Naturopathy, Ayurveda, and Diet therapy techniques for 27 days and followed the same protocol for a year and was successfully able to achieve positive results in the condition.

doi: 10.38205/imcr.030125

*Corresponding Author:
Reshma P. Jogdand
Department of Life sciences
SVYASA University, Bangalore, India
Contact no: +91-9449164937



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).


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


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


Figure 1: Pathogenesis of multiple myeloma


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

  Rounds Session per day
1. Loosening Practice (15, 16)
Hand Stretch Breathing. 10 Twice a day
Hands in & out Breathing in sitting Position. 10 Twice a day
Ankle Stretch Breathing in sitting position. 10 Twice a day
Tiger Breathing 10 Twice a day
Straight leg raising alternate leg. 10 Twice a day
Setubandhasana Breathing. 10 Twice a day
Folded leg lumber stretch. 10 Twice a day
Bhujangasana Breathing 10 Twice a day
2. Shakti vikasaka practice (17,18)
ManibandhaSakitVikasaka (Wrists) 10 Twice a day
KaraprastaAaktiVikasaka (Back of Hand) 10 Twice a day
Kaphonoi Sakti Vikasaka (Elbows) 10 Twice a day
Griva Sakti Vikasaka (Neck) 10 Twice a day
3. Pranayama (19)
Sectional Breathing 15 Once in a day
SuryanulomaVilama 15 Once in a day
Cooling Pranayama 9 Once in a day
Nadisuddhi 15 Once in a day
ChandranulomaVilama 15 Once in a day
Bhamari 9 Once in a day
4. Kriya (20)
Kapalabhati. 1 min Once in a day
5. Meditation
OM Meditation (21) 35 min Once in a day
Cyclic Meditation (22) 30 min Once in a day
Mind sound resonance technique (21) 30 min Once in a day
Pranic Energising Techniques (23) 45 min Once in a day
Steps of Pranic Energising Techniques:
The following are the eight steps of Pranic Energising Techniques
1. Opening prayer “präëasyedaà vaçe sarvaà …”
2. Breath Awareness or Balancing of Breath
3. Recognition of Vyana
4. Movement and Rotation of Vyana
5. Balancing and Energisation
6. Silence
7. Resolve … 9 rounds
8. Closing prayer “serve bhavantu …”

Ayurveda protocol

Table 2: Ayurveda Protocol

Internal Ashwagandha vati
External Mrudu abhangyam

Naturopathy protocol

Table 3: Naturoapthy Treatment

Days 7:00 am 2:00 pm
Saturday Mud pack to the abdomen and eye pack + Neutral Enema Head massage + Neutral foot bath
Sunday Kriya Partial massage to shoulder, Neck, and Back + Hot fomentation to back
Monday Mud pack to the abdomen and eye pack Neutral Underwater massage
Tuesday Mud pack to the abdomen and eye pack Full body massage + Steam bath
Wednesday Mud pack to the abdomen and eye pack Partial massage to legs and hot foot bath
Thursday Mud pack to the abdomen and eye pack Neutral underwater massage

Diet plan

Table 4: Diet guidelines

  Breakfast (8:00 am) Juice Lunch (1:00 pm) Dinner (7:30 pm)
Friday Khichadi/Daliya
Poha/Boiled Sprouts/Upma
Veg khichadi/Daliya
Sprout juice 1 chapati + 1 cup dal + 1 cup rice + 100 gm boiled veg + Butter milk with jeera powder 1 chapati + 1 cup dal + 1 cup rice + 100 gm boiled veg + Vegetable soup/Buttermilk with jeera powder
Saturday Sprout juice
Sunday Sprout juice
Monday Sprout juice
Tuesday Sprout juice
Wednesday Sprout juice
Thursday Sprout juice
Organic sprout juice (24) Recipe:
Sprouts are considered a nutritious intake as the sprouting process increases nutrient levels, making sprouts richer in protein, folate, magnesium, and vitamins C and K than un-sprouted plants. Sprouts also contain a level of anti-nutrients which makes absorption easier. Sprouts are also great sources of antioxidants and fiber.
Ease Digestive function
All nutrients get absorbed soon.
Good for Weight gain
Reduce oxidative stress
Nutritional values:

Enhanced cell growth and repair

Improvements in blood clotting and infectionfighting.


Plays a key role in DNA synthesis, repair, and methylation.


Maintain magnesium homeostasis.

Protective agent against chemotherapy-induced nephrotoxicity and neurotoxicity.

Vitamin C

Block the metabolic activation of carcinogens

Stimulate immune function

Effective against oxidative stress.

Vitamin K

Inhibit cancer cell growth and promote apoptosis


Flushing cancer-causing compounds out of the body.

  Ingredient Quantity
1 Javegodhi (native wheat) 1 kg
2 Unpolished rice 1 kg
3 Foxtail 1 kg
4 Little millet 1 kg
5 Ragi 1 kg
6 Green gram 150 g
7 Bengal gram 100 g
8 Horse gram 100 g
9 Alfalfa 100 g
10 Groundnut 100 g
11 Black-eyed peas(alasand) 100 g
12 Peas 100 g
13 Broad beans 100 g
14 Amaranth seeds(not sprouted) 100 g
Preparatory procedure:
• Take all grains and mix in well in a container
• Make it small quantity of it for daily use (use a standard cup measurement)
• Whenever you are taking for preparation first wash properly
• soaked for 12 hours and sprouted for 12 hours
• Soak nuts, seeds, dry fruits 12 hours
Preparation of juice:
• Grind sprouts and (nuts, seeds & dry fruits) separately.
• Bring it to a thin consistency and bring it to a boil to make kanji.
• Now add ground nuts, seeds, and dry fruits.
• Mix & serve.
Dose: Three times/meals per day (Approximately 60 g (sprouted grains) quantity per meal)
Anupan (take juice with the following anyone)
Rock salt/Black pepper/Jeera powder

Subjective symptoms

Table 5: Subjective Symptoms

Symptoms Pre Post
Acute pain in the Right shoulder. Present Absent
Acute lower back pain occurred.
Difficulty in walking/movement.
Nausea, stomach upset, frequent vomiting.
Loss of appetite.
Extreme fatigue.
Deep Venous Thrombosis.
Prone to viral infections
Pain scale 8 0

Key parameters reading

Table 6: Follow up key parameters

Key parameters April 2019 April 2019–Jan 2020
(after 24 weeks of medication + chemotherapy)
Sep 2020 Sep 2021
serum protein electrophoresis (SPE) 4.8% g/dl 0.26% g/dl (Jan 2020) 0.51% g/dl No monoclonal band seen
Free light chain Kappa Light chain: 127.0 mg/L
Lambda light chain: 10.5 mg/L
Kappa/Lambda Ratio: 12.0952
Kappa Light chain: 31.3 mg/L
Lambda light chain: 26.9 mg/L
Kappa/Lambda Ratio: 1.16 (Jan 2020)
Kappa Light chain: 25.70 mg/L
Lambda Light chain: 21.70 mg/L
Kappa/Lambda Ratio: 1.184
Kappa Light chain: 13.8 mg/L
Lambda Light chain: 14.4 mg/L
Kappa/Lambda Ratio: 0.95
Bone marrow 50% plasma cells 1% plasma
cells (August 2019)
4% plasma cells NIL
PET CT 1. Known case of multiple myeloma
2. Multiple metabolically active skeletal lesions.
3. The collapse in D10, L4 vertebra. And activity in the Right Scapula, Sternum, Sacrum, neck of the left Femur.
1. Multiple osteolytic lesions in the skeletal system with mild-to-moderate metabolic activity, suggestive of residual multiple myeloma. 1. Significant increase in the area of lysis and associated soft tissue component of size 4.0 × 2.2 involving the inferior Right scapula with a marked increase in metabolism. 1. Marked regression in metabolism. Of inferior right scapular osteolytic region.
2. Further regression in the metabolism of some of the multiple Osteolytic lesions in the skeleton system.
  4. No evidence of active disease is seen elsewhere in the body to suggest active disease. 2. Regarding PET CT done in April 2019, there is mild-moderate regression of metabolic activity in skeletal lesions, suggesting partial response. (August 2019) 2. Multiple osteolytic lesions in the skeletal system with interval regression in metabolism.
3. No morphological change was noted associated with the partially collapsed body of the L4 vertebra with an interval increase in metabolism.
3. Stable partially collapsed body of L4 vertebra.
Deep vein thrombosis (DVT)
Left lower limb
    Persistent left lower limb DVT involving mild & distal SFV with intense appearance of unstable partially occlusive floating thrombus in proximal SFV. 1. Complete recanalization of mid-distal superficial vein and saphenous vein
2. No evidence of deep/superficial
3. Venous thrombosis.

Vital parameters pre and post reading

Table 7: Pre-post Vital parameters

Parameters Before (18th Oct 2019) After (14th Nov 2019)
Pulse Beats/min 92 bpm 64 bpm
BP in mmHg 142/102 140/80
Respiratory Cycles/min 20 cpm 10
Bhramari Time (Sec) 7 12
Symptoms score 6 4
Medication score* 04 00
Weight in Kg 80 80

*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.


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.


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.


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.


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


Source of funding


Conflict of interest



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


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