Tuesday, December 2, 2014

The Grand Unified Theory of Transplants -- or "To Transplant or Not to Transplant"

Hello folks.

I do a fair amount of outreach in the online and real world, and I've noticed that time and time again the same questions are being asked about transplants that were asked five years ago.  Should they be done at all?  Should they be done up front or later?  Should there be one or two?  It also occurs to me that doctors -- even the most brilliant ones -- may or may not be excellent at making decisions the way they are made in business, or even explaining concepts.  So I'm going to approach this using the reasoning that I've learned and applied outside the medical field and outside research to try to provide a different perspective.  I'm not a doctor -- so please take all this with the knowledge that I'm just trying to make sense of something from a layman's point of view.  I'd like to acknowledge the help of my good friend a fellow MM warrior Suzierose, aka Myeloma Cinderella, who is no fan of transplants (for well-founded reasons) but who has vetted the substance of what I write below.

We're talking about auto transplants here, by the way, not allo transplants.

What a Transplant Is, and What a Transplant Is Not.

A transplant, first of all, is not really a transplant.

Think of a transplant as high dose Melphalan[1] instead.  Melphalan is a type of chemotherapy.  That’s it to a transplant, nothing more, nothing less: a transplant really is just a lot of chemo.  After this, you get your own blood back to help you recover.  That’s it.  There’s no “transplantation” and getting the blood back serves no purpose in killing the myeloma.  The purpose of an auto transplant is to kill Myeloma with Melphalan.  This is in contrast to an allo transplant, the purpose of which is to kill Myeloma by introducing a donor’s immune system.  That is an entirely different ball of wax.

An auto transplant is not a transplant of anything.  I suppose you could call it a replant.  But it’s best thought of as high dose Melphalan.

What a Tandem Transplant is.

It follow from the above that a tandem transplant is nothing magical – it’s just double the amount of Melphalan.  If you’re doing it spaced a year apart, it’s not a tandem transplant -- it’s two single transplants.  The purpose – and value – of a tandem is simply to give you twice as much of the chemo at a time when the disease hasn’t yet become resistant to it.

Do transplants work?

Often, but not always.  It depends on what type of disease characteristics you have: very simply, if you have disease that is susceptible to Melphalan, a transplant will very likely be effective.  If you have disease that is not susceptible to Melphalan, a transplant will probably not be very effective.

Melphalan works by changing the DNA of cells in the bone marrow and getting in the way of certain processes that cells need to survive.  This process is called alkylation.  The Melphalan adds something to the DNA of cells that kills them.[2]

This kills a lot of cells.  It may not kill all of them; it may not kill enough of them; and it might also piss off the ones that survive.  It depends on whether or not the patient has myeloma that is susceptible to this precise type of treatment.  Most patients (80-85%) have cells that will be sufficiently killed by Melphalan to have some response.   Of that group, maybe half of them require a LOT of Melphalan to kill all the cells.

However…if the patient has cells that do not respond to Melphalan, not all the cells will be killed and the process of changing the DNA could result in an outcome where the remaining cells are resistant to this or other kinds of treatment, or whereby they mutate more rapidly and/or chaotically.

From this, a couple of things can be explained.  First, when people talk about “high risk disease” they have traditionally been talking about disease that has characteristics in common with other patients whose MM cells haven’t been killed sufficiently by Melphalan (or by other medicines).  Second, this explains the role of tandem transplants – some people need more Melphalan than others to kill all the cells.  Which explains when Melphalan was used by itself got 30% remission rates, but tandems do much better than that.

Do other types of therapy do the same thing?

Other types of therapy can be very effective, but don’t necessarily do the same thing.

Here are a few alternatives based on therapy I’ve received.

Traditional chemo used against newly diagnosed Myeloma comes in several flavors:

  • Cisplatin (the “P” of “PACE” therapy, which stands for platinum) works in a similar way.  It also monkeys with the guanine DNA.  It interferes with cell division, which is slightly different than the interference from Melphalan.  When the cell finds out that it can’t divide, it tries to repair itself.  When repair proves futile, the cell politely dies.  But cells have a way of learning to bypass platinum over time.
  • Adriamycin, the trade name of Doxyrubicin, is the “A” in “PACE” therapy (and Doxil is a modified version).  These drugs also interfere with DNA through a process celled intercalation (which disrupts DNA and the process through which cells replicate).
  • Cytoxan (the trade name of Cyclophosphamide, the “C” of “PACE” and the Cy of the CyBorD treatment) works in a very similar way to Melphalan.
  • Etoposide is the “E” of “PACE” and works differently.  It screws up a different part of the cell replication process by messing around with an enzyme that is needed by DNA strands during cell duplication, and causes those strands to break.  Cancer cells divide more rapidly than healthy cells and are more reliant upon this enzyme than healthy cells, so they are disproportionately effected.

Then there are two classes of drugs that have come to be called “novel agents.”

  • IMIDs (the class of drugs that includes Thalidomide, Revlimid and Pomalidomide) work by inhibiting cells in the bone marrow that support the Myeloma cells, and by inhibiting the growth of blood vessels that Myeloma relies upon.

  • Proteasome inhibitors (which include Velcade and Kyprolis) interfere with the process through which cells remove abnormal or misfolded proteins (and thus help the cell to survive).  When this process is interfered with, the cell eventually realizes it has too many abnormalities and politely dies.

Oh, and we can’t forget steroids.  Steroids suppress the immune system and kill plasma cells.  There’s prednisone, which is not as powerful or as effective as Dexamethasone.  If you’re killing plasma cells, you’re killing MM cells (they sit in the plasma).

It goes without saying that none of this is healthy.  The purpose, obviously, is to kill cells.  Killing cells through disrupting DNA is nastier and more chaotic than killing cells through other means.  Consequently, there are more side effects – both near-term and long-term – from chemotherapy that messes with DNA.  Patients must judge for themselves whether or not the additional side effects are worth the additional killing power.

Do transplants work as well as other types of therapy?   Do other types of therapy work just as well as transplants?

The answer is we don’t know yet.  We do know they work differently. 

Think of it this way.  The cells in group A, above, are only sensitive to alkylators like Melphalan.  Dr. Roger Tiedemann at Princess Margaret Hospital in Toronto has shown that in vitro (that is, in a lab outside the human body) the precursor cells of Myeloma do not exhibit the cell structure required to be susceptible to novel therapies.  His research shows that alkyalytors are essential to kill these precursor cells.  In other words, these cells exist in group A and they can’t be touched by novel drugs like IMIDs and proteasome inhibitors.  Those other drugs are the equivalent of moving a lawn full of weeds -- you are getting rid of the parts of the dandelion that you see, but the roots are still there and no amount of lawn-mowing will stop the weeds from growing back.  Not everybody agrees with this research..but it’s an idea to consider.

In group C are cells that are sensitive to Velcade or Revlimid but are not sensitive to Melphalan.  By definition, “high risk” MM either exists in quadrant C here (since Melphalan doesn’t work for very long, if at all, on some disease biology) or it exists outside these circles completely and requires that new solutions be found.  There is concern that for patients with disease that is not killed by Melphalan, the results of screwing with that DNA can cause advanced mutations in the MM cell that can make it more aggressive.  This explains why Total Therapy with Melphalan doesn’t work long-term for high risk patients, and explains why UAMS has moved away from transplants for those patients, as has Dr. Lonial at Emory.

Then there are those in group B – people with disease that could be killed by multiple means.   Here, do you just use Melphalan?  Or do you just use novel agents?  Or do you use both?  This requires a perspective on the concept of synergy between medicines, which I attempt to explain below.

The concept of synergy

There’s one more piece of the puzzle before we can start putting this all together.   It’s a pretty simple notion: the idea that multiple medicines work better together than individually.  Myeloma is smart.  Permit me a crude analogy:

If the Myeloma cells are in a room with one door, think of the medicine as a helpful monster preventing the MM from leaving the room, and eating the MM cells in the room who are panicking, looking for a way out.  The cells will start looking around for other ways out of the room, and will essentially cut a new door in the side of the room and leave through that new door.  The idea behind using multiple agents is that every potential door the MM might cut in the room has another type of medicine standing behind it and ultimately one or more of those monsters eats the cell before it can get out of the room somehow.

The concept of so-called “triplets” (e.g., VRD) and “doublets” (e.g., Rev + Dex) working better than single agents is established and pretty much universally accepted at this point.  This also explains why transplants done before the era of novel agents didn’t perform as well as transplants in the era of novel agents.  Synergy from using the drugs in combination created more durable response: deeper remissions and, in some cases, even cure.

It stands to reason that clobbering MM with VDT-PACE plus Melphalan plus VRD in maintenance is an aggressive version of this same philosophy – the question is whether or not there are a lot of patients in group B, above, who don’t need all of that – whether because their disease biology is particularly susceptible to novel agents alone, or whether because the newest novel agents (Kyprolis and Pomalidomide) are so powerful they can do a great job all on their own.   They need some synergy, but not as much as VDT-PACE offers.

When should one transplant?

Given what is laid out above, the decision on when to transplant is actually a much simpler one.

First, if you have disease that is unlikely to respond (or worse) to Melphalan, do not transplant.  How do you find this out?  You’ll need advanced bone marrow studies – such as UAMS’ gene array – to tell you what chromosomal abnormalities you have and you’ll need to learn whether or not those chromosomal abnormalities are consistent with those of patients who have not responded well to transplants.  Because per the first part of this little essay, it’s not that they aren’t responding to the concept of a transplant – it’s that Melphalan doesn’t work on that type of myeloma.

If you do have disease that is responsive to Melphalan, then the question becomes one of how extensive you (and your doctor) believe the synergies between medicines are:

- If you believe that there are real synergies between medicines, then transplant early, because you have naïve disease that will be confronted by as many different types of medicines as possible.  You’ll kill off most of the MM that way.

- If you believe that synergies don’t really make a difference, then transplant late.   You’ll kill off some of the MM with the first type of medicine, and when it returns, you’ll kill off some of it with the second kind of medicine (Melphalan).  Personally, I think this is a half-measure – both because I believe in the synergy and because I’ve seen too many friends have unsatisfactory results when they use Melphalan in this way (a “salvage” treatment after other forms of medicine have proven to be ineffective).   But when all those studies talk about overall survival being the same regardless of progression-free survival being different in those that transplant early, it’s because eventually, the Myeloma figures out how to saw a new door in the room and get out.  The early transplants block two doors up front, the late transplant simply waits until later to block the second door.  In both cases, the Myeloma eventually cuts a third door.  : (

- If you believe that synergies make a BIG difference, then consider total therapy and try to blow the MM out of the water.  The idea here is to surround the room with a lot of medicine monsters so that as soon as the MM tries to cut a new exit hole in the wall, it will be confronted with something.

Should there be one transplant or two?

In the context outlined above, the notion of a “tandem transplant” is easily considered and assessed.  Again, there’s no mystery to it: it’s simply twice the Melphalan at a time when the disease has not learned how to outwit Melphalan yet.  You might have disease that isn’t responsive to Melphalan in the first place, in which case it won’t make a difference.  You might have disease that is responsive to Melphalan but needs more than then usual dose, in which case it will make a difference.  It is Arkansas’ contention that most people need more than the dose from a single transplant in order to kill the disease versus just control it.

How long does a remission from a transplant last?

It depends.  On a lot.

It’s very hard to cite statistics, both because everybody’s disease is different because a transplant is not a transplant is not a transplant.

One transplant given to somebody who has relapsed from a lot of other medicine and done without maintenance cannot be compared against a transplant done at the onset of the disease with VRD administered at the same time – much less compared against tandem transplants in a total therapy setting.

If you have disease that is resistant to Melphalan, remission from transplant will be hard if not impossible to achieve in the first place, and won’t last as long as would be the case if you have disease that is NOT resistant to Melphalan.  And among those who have disease that IS responsive to Melphalan, if you believe in synergy, you will have a longer remission if you are treated with multiple agents at the same time plus maintenance than you will if you are treated with fewer agents.  If you don’t believe in synergy, then you would say that it doesn’t matter – but there are studies proving that maintenance does make a difference.

Where does this leave us?

If you are diagnosed when older, no need for a transplant as novel agents are good and getting better and they can lead to control of the disease for some time – remember, being cured just means living long enough to die of something else.  J

If you are young and do NOT have disease that responds to Melphalan, then I would try the best novel agents you can, treating the disease aggressively in the hopes of suppressing it as long as possible.  Immunotherapy is another option.

If you are young and have disease that responds to Melphalan, I would hit it hard Total Therapy style.

Ultimately, this is an individual disease – everybody’s biology is different.  It is paramount that the newly diagnosed patient understand the characteristics of his or her Myeloma so that he or she can make informed decisions with his or her medical team…which MUST include an MM specialist.  If your doctor can’t read what I wrote here and not only understand it but point out ten areas where I drastically oversimplified, then they shouldn’t be treating you.   :)

[1]I am ignoring for the moment the rare transplant that uses Bendamustine or another agent.

[2] Very specifically, for those who have are playing along at home with the Johnny Neutron Nuclear Medicine Home game, Melphalan adds an an alkyl group to the guanine base of DNA at the number 7 nitrogen atom of the imidazole ring.


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  11. شركة الكمال أفضل شركة تنظيف بحائل للتنظيف أهمية كبرى فى حياة الفرد وبالأخص المواطن

    السعودى مما
    يؤدى ذالك إلى تعرض المنزل بشكل كبير إلى الأتربة والأوساخ والبقع والدهون وأن نظافة

    المنزل تشعر الفرد بالراحة
    النفسية الكبيرة وتتكفل شركة الكمال بهذا العمل لأنها أفضل

    شركة تنظيف بحائل

    ولانها الشركة الرائدة
    والمشهود لها بالفضلى فى هذا المجال من النظافة لوجود المقومات التى تساعد على ذالك منها

    العمالة المدربة وذوى الخبرة
    والكفاءة مع وجود أحدث معدات التنظيف للفلل التى تساعد على إنهاء العمل بكفاءة ونهتم كثيرا

    بأراء عملائنا فى

    شركة تنظيف فلل بحائل

    ويقوم طاقم العمل بتنظيف الشقه بدون التسبب بأى إزعاج للعميل فلا تتباطؤ فى إختيار شركة

    الكمال لتنظيف منزلكم لأنها أفضل

    شركة تنظيف شقق بحائل

    ولأن تنظيف المجالس يحتاج إلى وقت وجهد كبير فشركة الكمال أفضل شركة تنظيف
    مجالس بحائل كفيلة بتنظيف مجلسك فى أسرع وقت وبدون جهد وبالتالى شركة الكمال هى الحل

    الأمثل فى فى مجال تنظيف المجالس
    بحائل ونحن بانتظاركم لتتصلوا على

    شركة تنظيف مجالس بحائل

    وأفضل مايميز شركة العربى أفضل شركة تنظيف منازل بحائل وضعها للخطط قبل البدء فى
    شركة تنظيف مجالس وكنب بحائل
    شركة تنظيف سجاد

    وموكيت بحائل

    العمل وتقسيم طاقمها إلى
    مجموعات كل منها مختص بتنظيف جزء معين وتمر عملية التنظيف على عدة مراحل :-
    1- البدء بتنظيف الموكيت والكنب والمفروشات والسجاد بالأعتماد على أحدث المعدات

    الألكترونية التى تعمل بالبخار لكى
    تقضى على المشاكل التقليدية للتنظيف وهى بهتان اللون وبذالك قمنا بالأعتماد على البخار فى

    إزالة الأوساخ والبقع
    2- ثم بعد ذالك يأتى دور البلاط والأرضيات فيقوم العمال بجلى البلاط والأرضيات بأحدث

    ألالآت جلى البلاط والأرضيات

    شركة تنظيف واجهات بحائل

    شركة الكمال أفضل شركة تنظيف خزانات بحائل نظرا لارتفاع درجات الحرارة فى حائل وفى
    غيرها من باقى مدن
    المملكة ووجود مياه البحر المحلاة التى تحمل الكثير من الرمال والأتربة مما يؤدى
    ذالك إلى تكون الفطريات والجراثيم على
    جدران الخزان ويؤدى ذالك إلى تلوث المياه والتى بدورها تؤدى إلى تسمم الفرد إذا فما الحل ؟
    الحل تقدمه لكم شركة العربى وهى أفضل
    شركة الكمال أفضل (( شركة كشف تسربات المياه بحائل )) نسعى فى شركة الكمال بتقديم كافة

    خدمات كشف تسربات المياه ويتم كشف تسربات المياه بأحدث
    الأجهزة الألكترونية و طاقم عمل يتكون من فنيين وخبراء منهم فنيين أجانب ونسعى جاهدين

    لتقديم أفضل خدمة بأقل سعر وإرضاء العميل واسعارنا حصرية لا تقبل المنافسة لدينا فى

    شركة كشف تسربات المياه بحائل

    شركة الكمال أفضل (( شركة نقل عفش بحائل )) نقل العفش من الأمور الهامة جدا (( شركة نقل

    عفش بحائل )) التى يلزم فبها الدقة والخبرة للحد ولذالك خصصنا قسما فى شركتنا لمجال
    نقل العفش مع تجهيزه :-
    1- أسطول كبير من السياراة المجهزة والتى (( شركة نقل عفش بحائل )) أعدن خصيصا

    لنقل العفش
    2- طافم العمل المدرب على حمل وتنزيل العفش والأثاث
    3- فنيين متخصصين فى الفك والتركيب (( شركة نقل عفش بحائل ))
    ومايجعل نقل الاثاث من أشهر الخدمات التى يكثر عليها الطلب هوا أن معظم العملاء يقومون

    بتغيير عفشهم القديم أكثر من مرة فى العام ويرجع ذالك أيضا إلى أنا
    العملاء يقومون بتأجير الفلل والقصور والشقق وذالك لأنهم يحبون تغير الجو ولذالك يكون اعتما

    نا فى شركة العربى على أحسن تقنيات نقل الاثاث بداخل وخارج
    حائل ونقل الاثاث من الأعمال شديدة الكثافة لذا تحتاج إلى

    شركة نقل اثاث بحائل

    دقة عالية ومهارة فى فك العفش وحمله وإنزاله إلى السياراة وتغليفه لتقليل من شدة الصدمات

    تعرضه للكسر وللخدش أيضا ونستخدم فى شركة العربى أفضل وأحدث السيارات المجهزة

    خصيصا لنقل العفش

    Is my pleasure to comment on this site and i thank the admin of this site for his/her great work so far.one of the happiest moment in my life was when the doctor confirm that my wife is been free from this illness. this awesome moments makes me the happiest man on earth, I really don't know how to thank DR WILLIAMS for helping my wife get cured for over how many year of suffering from myeloma. i came across DR Williams contact through a headline news on internet about how DR Williams help a woman to get cured of her myeloma and so many other with similar body problem ,i contacted him and he told me how to get his herb,few day later he sent me the herbal portion which my wife take every morning for 28 days, and his medicine was able to cure her completely from myeloma. and now she very mush okay without any side effects whatsoever, If you have myeloma , you can contact him on his email address drwilliams098675@gmail.com for advice and for his product.

  13. I battled with ZERO SPERM COUNT ( Azoospermia ) for years until 6 months ego, I told my father in-law my problem because everybody was asking questions why we hasn’t got any kids after 9 years of marriage. I couldn’t help it than to break the silence to my father in-law, he gave me doctor Uduehi’s contact and I contacted him without wasting time, after I applied his medications I started experiencing sperm, although it was little at the benign but after a shot while it became more than 16 million. My wife is 2 months pregnant as I speak. You too is not left out, reach him if interested through: uduehiherbalcare@gmail.com phone/WhatsaPP: +2347084878384

  14. Brothers and sister, let me use these opportunity to introduce a great doctor that cured ME FROM HIV/AIDS WITH HIS HERBAL MEDICINE. Dr Akhigbe, he is also know as the godfather of berbalism and all kind of root to cure different diseases.i meant his different testimonies on this blog site i also reach him through his email. first he encourage me with good advise, he told me to stop thinking on about the HIV and let my mind be free.secoundly he learnt me a short lesson that was very cleard to me and make me to understand that using condom when having sex is best protction. how ever,
    The period of HIV infection to develop in the body is about three to four weeks. This period can, however, be longer up to 3 months and in rare cases up to 6 months. Most people generally develop detectable HIV antibodies by current method within 3 months of infection or to 6 months before it expand to years.Dr Akhigbe feel for patienas as his own sons and daughters he sent my herbal medicine through UPS express delivery and it took me 5 working days before i received it, he also instruction me on on how to use it. he is a good caring doctor he must write me each day to know if am following up with the herbal merdicine for good three weeks before he later order me to go to hoapitle for another test and i get a surprise result, that was how i get my freedom from the hand of hiv/aids.Dr Akhigbe also use his herbal medicine to cure diseases like HERPES ,HIV/AIDS , DIABETES , CANCER , ALS etc for his help please reach him through his email drrealakhigbe@gmail.com or whatapp him +2348142454860

  15. My name is donald boykins , am here to appreciate Dr Akhigbe for using his herbal medicine to cure my Herpes virus. Is about 3 years and 6 months now I have been living with this virus and it has been a serious problem to me, I was so confused cause i have been taking several drugs to be cured but all of my effort was in vain,one morning i was browsing through the internet then i saw several testimonies about Dr. Akhigbe curing people from Herpes virus and immediately i contacted Dr. Akhigbe on his email: drrealakhigbe@gmail.com, i told him about my troubles and he told me that i must be cured, he gave me some instructions and which i rightly followed. so he prepared a herbal medicine and sent it to me which i used for 2 weeks and i was cured everything was like a dream to me and my Herpes virus was totally gone, dr .Akhigbe, God bless you and give you more power and ability for more cures.i dont know if there is any one out there suffering for herpes virus or any of these diseases..DIABETES, CANCER, HIV/AIDS, HERPES HEPATITiES A AND B DISEASES .etc why don't you contact dr.Akhigbe today and be free from your diseases because he is very good and honest Doctor and he is also called the godfather of habalism contact him via email; drrealakhigbe@gmail.com or whatsApp him on +2348142454860

    I was diagnosed of myeloma in 2011, I have tried all possible means to get cure but all my effort proved abortive, until a friend of mine introduced me to a herbal doctor , who prepare herbal medicine to cure different kind of diseases including myeloma , when i contacted this herbal doctor via his email, he sent me the myeloma herbal medicine via courier service, when i received the herbal medicine he gave me step by step instructions on how to apply it, when i applied it as instructed by Dr Williams i was totally cured from this disease within 1 months of usage. any body with similar problem can Contact this great herbal doctor via his email drwilliams098675@gmail.com for advice and for his product,and thanks to you admin for such an informative blog.

  17. I have being on blog Sites for a while now and today I felt like I should share my story because I was a victim too. I had HIV for 6 years and i never thought I would ever get a cure I had and this made it impossible for me to get married to the man I was supposed to get married to even after 2 years of relationship he broke up with me when he finds out I was HIV positive. So I got to know about Dr. Itua on Blog Site who treated someone and the person shared a story of how she got a cured and let her contact details, I contacted Dr. Itua and he actually confirmed it and I decided to give a try too and use his herbal medicine that was how my burden ended completely. My son will be 2 soon and I am grateful to God and thankful to his medicine too.Dr Itua Can As Well Cure The Following Disease… Cancer, HIV, Herpes, Hepatitis B, Liver Inflammatory,Diabetes,Fibroid, Get Your Ex Back, If you have (A just reach him on drituaherbalcenter@gmail.com Or Whatsapp Number.+2348149277967)He can also advise you on how to handle some marital's issues. He's a good man.

  18. As a sign of gratitude for how my wife was saved from myeloma, i decided to reach out to those still suffering from this.
    My wife suffered myeloma in the year 2016 and it was really tough and heartbreaking for me because she was my all and the symptoms were terrible, she always complain of bone pain, and she always have difficulty falling asleep . we tried various therapies prescribed by our neurologist but none could cure her. I searched for a cure and i saw a testimony by someone who was cured and so many other with similar body problem, and they left the contact of this doctor who had the cure to myeloma . I never imagined myeloma has a natural cure not until i contacted him and he assured me my wife will be fine. I got the herbal medication he recommended and my wife used it and in one months time she was fully okay even up till this moment she is so full of life. myeloma has a cure and it is a herbal cure contact the doctor for more info on drwilliams098675@gmail.com on how to get the medication. Thanks admin for such an informative blog.

  19. I am testifying about a great herbal doctor who saved me from AZOOSPERMIA , his name is Dr. Uduehi. I suffered zero sperm for many years, I’ve married twice and no woman could stay because of my inability to make them pregnant. I read about Uduehi’s medication online and I decided to try my luck, I contacted him and after using his medication my sperm count was 8 thousand and just like that it keeps increasing and its above 16 million as I speak and my wife is pregnant You too can become fertile just like me if interested. Contact him through: uduehiherbalcare@gmail.com phone/WhatsaPP: +2347084878384

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    I was diagnosed of myeloma in 2011, I have tried all possible means to get cure but all my effort proved abortive, until a friend of mine introduced me to a herbal doctor , who prepare herbal medicine to cure different kind of diseases including myeloma , when i contacted this herbal doctor via his email, he sent me the myeloma herbal medicine via courier service, when i received the herbal medicine he gave me step by step instructions on how to apply it, when i applied it as instructed by Dr Williams i was totally cured from this disease within 1 months of usage. any body with similar problem can Contact this great herbal doctor via his email drwilliams098675@gmail.com for advice and for his product,and thanks to you admin for such an informative blog.

  22. I have long felt a special connection with herbal medicine. First, it's natural, Charlie attended the same small college in Southern California - Claremont Men's College - although he dropped out of school to enroll in the Julliard School of Performing Arts in New York. York. Had he been to Claremont, he would have been senior the year I started there; I often thought that was the reason he was gone when he discovered that I had herpes. So, my life was lonely, all day, I could not stand the pain of the outbreak, and then Tasha introduced me to Dr. Itua who uses her herbal medicines to cure her two weeks of consumption. I place an order for him and he hands it to my post office, then I pick it up and use it for two weeks. All my wound is completely healed no more epidemic. I tell you honestly that this man is a great man, I trust him Herbal medicine so much that I share this to show my gratitude and also to let sick people know that there is hope with Dr. Itua. Herbal Phytotherapy.Dr Itua Contact Email.drituaherbalcenter@gmail.com/ info@drituaherbalcenter.com. Whatsapp ... 2348149277967
    He cures.
    Breast Cancer
    Brain Cancer
    Hepatitis,Glaucoma., Cataracts,Macular degeneration,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis.Alzheimer's disease,
    Dementia.Tach Disease,Shingles,
    Lung Cancer
    HIV,Arthritis,Amyotrophic Lateral Scoliosis,Fibromyalgia,Fluoroquinolone Toxicity
    Cervical Cancer
    Colo-rectal Cancer
    Blood Cancer
    Liver / Inflammatory kidney

  23. I am not sure of the cause of COPD emphysema in my case. I smoked pack a day for 12 or 13 years, but quit 40 years ago. I have been an outdoor person all my adult life. Coughing started last summer producing thick mucus, greenish tint to clear. I tried prednisone and antibiotics, but no change. X-rays are negative, heart lungs and blood and serum chemistries all are normal. I have lung calcification from childhood bout with histoplasmosis. I am 75 years old and retired.My current doctor directed me to totalcureherbalfoundation @g mail. com which I purchase the COPD herbal remedies from them ,they are located in Johannesburg, the herbal treatment has effectively reduce all my symptoms totally, am waiting to complete the 15 weeks usage because they guaranteed me total cure.


  25. I'm 55-year-old from Korean, I was diagnosed with second-stage liver cancer following a scheduled examination to monitor liver cirrhosis. I had lost a lot of weight. A CT scan revealed three tumors; one in the center of my liver in damaged tissue and two in healthy portions of my liver. No chemotherapy or radiotherapy treatment was prescribed due to my age, the number of liver tumors. One month following my diagnosis I began taking 12 (350 point) Salvestrol supplements per day, commensurate with my body weight. This comprised six Salvestrol Shield (350 point) capsules and six Salvestrol Gold (350 point) capsules, spread through the day by taking two of each capsule after each main meal. This level of Salvestrol supplementation (4,000 points per day) was maintained for four months. In addition, I began a program of breathing exercises, chi exercises, meditation, stretching and stress avoidance. Due to the variety of conditions that I suffered from, I received ongoing medical examinations. Eleven months after commencing Salvestrol supplementation But all invalid so I keep searching for a herbal cure online that how I came across a testimony appreciating Dr Itua on how he cured her HIV/Herpes, I contacted him through email he listed above, Dr Itua sent me his herbal medicine for cancer to drink for two weeks to cure I paid him for the delivering then I received my herbal medicine and drank it for two weeks and I was cured until now I'm all clear of cancer, I will advise you to contact Dr Itua Herbal Center On Email...drituaherbalcenter@gmail.com. WhatsApps Number...+2348149277967. If you are suffering from Diseases listed below, Cancer, HIV/Aids, Herpes Virus,Bladder cancer,Brain cancer,Colon-Rectal Cancer,Breast Cancer,Prostate Cancer,
    ?Esophageal cancer,?Gallbladder cancer,Gestational trophoblastic disease,Head and neck cancer,?Hodgkin lymphoma
    ?Intestinal cancer,Kidney cancer,Leukemia,Liver cancer,Lung cancer,Melanoma,Mesothelioma,?Multiple myeloma,?Neuroendocrine tumors,Non-Hodgkin lymphoma,?Oral cancer,Ovarian cancer,?Sinus cancer,Skin cancer,Soft tissue sarcoma,Spinal cancer,Stomach cancer,Testicular cancer,Throat cancer,Thyroid Cancer,?Uterine cancer,Vaginal cancer,?Vulvar cancer,Hepatitis, Chronic Illness. Lupus,Fibromyalgia.

  26. والصدق والامانه فى العمل ، وهدفنا هو ارضاؤك وراحتك ، لا تقلق ونحن معك

    شركه عزل فوم بالجبيل
    لا تجهد نفسك ونحن تحت امرك ورهن اشارتك .
    أبرز خدمات مؤسسة الحرمــين للمقاولات العامة بالدمام والرياض

    شركه عزل فوم بالدمام

    شركه كشف تسربات المياه بالاحساء