What dietary supplements should myeloma patients consider asking their doctor about taking?

That's a good question. And most patients ask it because we all want this simple fix of like with supplements and increase our health overall.

So a couple of things with vitamin D, I think there is a lot of data with myeloma and vitamin D, Vitamin D is probably the most common vitamin deficiency in the world, but it's especially common in myeloma patients.

And about 75% of the patients would be either insufficient or deficient in vitamin D in myeloma. So I think every patient who is diagnosed with a plasma cell disorder should be tested for it. Once it's tested, you should try to maintain your levels over 30 nanograms per ML and there have been numerous studies looking at vitamin D levels and outcomes.

So vitamin D levels in myeloma associated with low levels are associated with increased inflammation, decreased bone density, decreased overall survival, decreased bone progression, free survival, increased number of plasma cells in the bone marrow.

But that's a small study. So, I wouldn't put too much weight on it, but I think there are enough studies showing that the vitamin D levels being low can impact outcomes.

Other supplements, curcumin. I know I see a lot of patients on it, and the reason patients are on curcumin is based on one study that was done in Australia. This study looked at a small number of patients with MGUS and smoldering myeloma. What the study did was give patients two grams of curcumin C3 complex twice daily for three months, and then increase it to four grams twice daily for three months and then looked at outcomes in myeloma.

What they did show there is that no patient progressed on that study, but as we know, it takes time for progression and the study didn't look that long. So it's hard to know whether the curcumin truly impacted it.

And so curcumin C3 complex may be associated with a decreased risk of myeloma long term, but we don't really have robust data for that.

I know that there was one case report published in 2017 that showed a patient who was in their third relapse of myeloma, took curcumin supplements and did put the myeloma into remission for over five years.

That's only one case report, and I wouldn't go by that and say you shouldn't take your myeloma directed therapies at all. But, there are these rare cases that may have seen a benefit with it.

Do I recommended to all patients? I don't. But if a patient is interested or asks me about supplements, I do mention that there is a little bit of data around it.

Curcumin has anti-inflammatory properties which may be related to its anti-cancer properties as well.

Resveratrol with myeloma, there isn't any data, but it's been looked at. I actually I'm not too familiar with the cancer specific data for it, but I know that people have looked at it for longevity and thought that there might be a signal to improving longevity.

But resveratrol comes from these grapes and things.

So just eating grapes might be a solution instead of trying to isolate the resveratrol and only eat that.

So other supplements that I can talk about would be vitamin B12.

I see some, it's another vitamin that patients are often deficient in.

And I wouldn't again take it right off the bat for everyone. But I would say that if your levels are low, if you have neuropathy or anemia, then those levels should be checked.

generally when a patient has myeloma and anemia, I do check folate levels, B12, iron, and if any of these are low, I think they need a depletion. If a patient has myeloma neuropathy, I think it's important to check B1, B6 and B12 levels. And then if any of these are low, replete them because even though there is the bortezomib associated neuropathy, if there is another factor like a vitamin being low or something, it maybe exacerbate it.

So bringing those levels to normal can be helpful, but I wouldn't recommend a supplement for everybody all the time.