Search This Blog

Loading...

Sunday, July 13, 2014

3rd Anniversary

Three years ago today, Gretchen and I sat in Dr. Richardson's office as he acknowledged that I had progressed from Smoldering Myeloma to full-fledged Multiple Myeloma.  By then, I had done enough research to know that this was serious news indeed.  At that moment, both of our lives changed forever.

I am thinking back on the feelings I had that day in Paul's office.  Was I scared?  Yes, but something about Paul's manner was very comforting and soothing.  He looked into my eyes and said confidently, "You are going to live into your eighties".  Just like that.  What might have been a traumatic experience suddenly became more one of concern and resolve.  Dr. Richardson's optimism gave me hope.  I immediately signed up for the MLN9708 clinical trial he offered me, and from that moment on, I embarked on a mission of "How am I going to beat this thing?".  It was now my job to research everything I could about MM and to participate as much as possible in my own care.

Over the past three years, I never dwelt on the question of "Why did this have to happen to me?".  Shit happens, so just deal with it!  Of course I was very fortunate to have responded so well to the therapy.  I don't know to what extent my positive attitude had to do with it, if at all.  In any case, I am blessed to celebrate this 3rd anniversary in Complete Response (CR).

In the intervening time, great strides have been made in the search to contain or cure MM.  The many new drugs available give additional hope to relapsed/refractory patients.  Recent research on monoclonal antibodies, immunization therapies, nanoparticles, gene therapy, personalized treatments, and other promising approaches have opened new frontiers in the fight against this disease.  I am fortunate to have Dr. Richardson and to be at the Dana Farber Cancer Institute, the epicenter of much of this research.

Every month as I go back to the Farber for my blood test and Zometa infusion, I have a bit of anxiety as to whether my remission continues.  I know that it is inevitable that on one of these visits, I will find that MM has reared its ugly head again.  But that could be many months or even years away, and when that happens, it will just be a new phase in the ongoing fight.  Dr. Richardson's words on that first day are ringing in my ears.  My eighties are still 9 years away.  You gave me your word, Paul, and I believe!

Monday, July 7, 2014

Soggy 4th

Rainbow in Newburyport
Usually, we go up to the farm in upstate New York over the 4th of July, but this year schedule conflicts got in the way, so we stayed home.  On the bright side, I saved about $200 on illegal fireworks.  Jason and his girlfriend, Jessica, came up Wednesday and Thursday.  Jeff joined us for a boat ride down the Merrimack River to Newburyport for dinner at the Black Cow on Wednesday.  On the way back, we dodged a few raindrops, but were treated to a beautiful rainbow.  It was a delightful evening on the water.

We hosted a cookout on Thursday with Jason, Jessica, Jeff, and Christine.  The weather, food, and company were all great.  Fortunately, we had no big plans for Friday, the 4th, when the deluge from Hurricane Arthur doused us thoroughly.  Still, we went to visit Gretchen's brother, John, and Kathy for an intimate family cookout.  My job was to hold the umbrella while John grilled chicken and burgers.  Due to inattentiveness, I kept dumping water off the umbrella onto him and the food, so I don't think I was much help.  I may lose my job for the next rainy cookout.

Interesting sculpture at Newcastle beach
Then on Saturday evening, Jeff and Christine came over for the night, and we spent Sunday at Great Island Common beach in Newcastle, NH.  There we had another cookout, walked the beach, and relaxed under the shade trees of this beautiful park.  A lovely day!

Except for Friday, the weather was great the whole time!  Looking back, I have warm memories of a wonderful time with our family.  The only thing missing was that our other two kids, Brian and family, and Holly and Ryan, weren't here.  That would have been a delectable icing on an already delicious cake.

Today I had my monthly visit to the Farber for blood tests and Zometa infusion.  The news was good!  My absolute neutrophil count (ANC), which was marginal last month at 1.09, rose to an almost normal level of 1.95 (normal is >2.0).  So I'm good to go with my Revlimid maintenance therapy for the next month.  My hematocrit also rose to 38.9 (normal range), the highest it has been since my diagnosis 3 years ago!  It appears that the iron supplements I am taking must be helping to reduce my anemia.  In other good news, I got my radiology report back from the complete bone survey x-rays I had done last month.  The bottom line is that there is no appreciable change from the survey a year ago!  Very good news, indeed.

A couple of things to note from the bone survey.  My skull showed small lucencies, which could either be due to benign "venous lakes" or "small myelomatous foci" (doc speak for MM lesions).  In any case, these have not changed since my first skeletal exam in 2011, so they are either benign or have remained under control since then.  Another notation of interest was: "Healed rib fractures involving at least the left fourth through 8th ribs appear unchanged from the prior exam".  Hmmm.  Do ya think that has anything to do with my fall from the ladder with the chain saw two years ago?  It certainly explains why I could barely get out of bed for next 6 weeks.  It was well-deserved punishment for my foolishness.

Dr. Richardson's nurse, Mary, indicated that since I have been on maintenance therapy for nearly two years now, I might be able to extend the Zometa infusion interval from one month to two or three.  She will check with Paul on that.  I won't get my hopes up, but that would be awesome.  Then I might be able to get my blood work done locally without fighting rush-hour traffic into Boston every month.  Please don't get me wrong here.  I am totally grateful that I am in remission and only have to go to the Farber once a month.  It could be so much worse.  I have no complaints whatsoever.  It's all good.

Sunday, June 29, 2014

Homeless

Friday we passed papers to sell our beautiful home in West Newbury.  We are delighted that the new buyer, Nancy, is really excited about moving here and loves this place as much as we have for the last 10+ years.  She has graciously allowed us to be tenants here for the next several months at a very reasonable rent, which should give us time to find a new place to live.

Our realtor, Sandy, has worked tirelessly for more than a year to help us sell this house, but I have to say that our cat, Sophie, really helped in the sale.   During the showing, Sophie followed Nancy all around the property as she looked at it, and Nancy said that she knew then that it was meant to be.  Here, Sophie is letting Nancy love her up while she went through the final walk through on Thursday.  No, I'm sorry, Nancy, but Sophie is not part of the sale.  We are really happy to be able to sell this house to someone who obviously cares for it as much as we have. 

But now what?  We are now squatters in our own home.  What next?  Where do we go from here?  A house?  A condo?  A rental?   We are now really free to consider many options, but it's kinda scary.  What if we got a condo?  Would I turn into a vegetable, transfixed on my computer all day, without any chores to do, no lawn to mow, no maintenance problems to address?  I certainly hope not.  I need something to wake up to in the morning and say yay, this is what I want to do today.  What about an over-55 community?  No kids, no joyous laughter during the day, just a bunch of grumpy old people.  Yes, it might be quiet, which would be a plus, but I don't know about that.  Gretchen loves young people, and I agree.  Young people help to keep you young. I don't want to grow old(er) ungracefully.  On the other hand, we don't want to end up next door to a bunch of teenagers with a loud stereo and boisterous parties either.  I dunno.

What if we just rent?  Then we would be free to travel the world and have time to look for the perfect place for us.  We don't know what perfect is, but we certainly haven't seen anything close to it yet.  Maybe we just put all our stuff into storage and stay with friends.  (To all our friends:  Don't panic, I'm just kidding.  We won't stay long.)

I had a wonderful time sailing with my friend Lew for 4 days last week.  We sailed down Buzzard's Bay to Newport and spent 3 nights on his boat.  Good sailing, good weather, good food, great camaraderie...it was very enjoyable and relaxing.

On a health note, I had a CBC diff blood test done last week at my local PCP provider to check on my absolute neutrophil count (ANC), which was marginal on my last visit to the Farber.  I have heard nothing back yet, which I interpret as good news, so I am continuing to take my daily Revlimid dose.



Thursday, June 12, 2014

Maintenance Cycle 23

It has been almost two years now into my maintenance therapy.  Tuesday I went back to the Farber for my monthly blood test and Zometa infusion.  I also met with Dr. Jean Marie Connors, a benign hematologist, to address my iron deficiency.  Her NP, Samira, collected all the medical information about me since I first noticed my anemia, back while I was exhausted trying to ski in Switzerland in December 2008 (I think).  I may have gotten some of my dates mixed up, but I recounted my persistent anemia, no matter what pills I took (Iron, B12), my long debilitating encounter with Lyme Disease (severe neck aches, a lost summer of chronic fatigue, fevers, chills, rashes, shooting pains, Bells's Palsy (twice), peripheral neuropathy, double vision, you name it), my arguments with my PCP about refusing to diagnose Lyme Disease, my escape to the wonderful naturopath, Dr. Mikulis, to finally diagnose and cure my Lyme disease, and my somewhat contentious relationship with the hematologist from Lahey Clinic who couldn't improve my anemia, finally leading up to his diagnosis that I had Smoldering Multiple Myeloma in May 2011.  What a nightmare those times were!  Of course, that's when I made a bee line for the Farber and was fortunate enough to get Paul Richardson as my oncologist, who diagnosed me with MM in July 2011.  Even though I now have MM, at least I know I'm getting the best care possible and I am happy with my current situation.

Dr. Connors noted that my iron levels have improved somewhat since December, when tests found them to be quite low.  She said that the Ferrex pills I am taking might take up to a year to return my iron levels to normal.  I  could make that happen faster by taking an IV infusion of iron, but I decided that as long as the trend is positive, I don't feel that I have to resort to extraordinary methods.  She agreed, so I got a new prescription to up the dose of Ferrex from 2 pills a day to 3, and I have an appointment in 3 months to see how that is working.

My blood test numbers this month continue to be good!  The pathology results from last month's serum and urine electrophoresis and immunofixation tests both show no M-spike and no monoclonal gammopathy.  So I continue to be in remission, which is wonderful.  All my other numbers were great, except for one.  My absolute neutrophil level dropped from 2.06 (normal range) to 1.09 this time!  Anything below 1.0 is cause to suspend the Revlimid, as it depresses the neutrophils, making me susceptible to infections.  That was somewhat of a surprise.  I now have to take another blood test in two weeks to see whether it has recovered or whether I have to take a hiatus from the Rev.  I'm taking the minimum dose of 5 mg/day, so I can't figure why this would be a problem.  Oh well.

There were some exciting new developments at the recent ASCO Conference.  I won't go into detail, but three new drugs are showing significant promise:  panobinostat, daratumumab, and SAR650984.  It's exciting to see that there is progress on multiple fronts in the fight against MM.  I'm sure I will be talking about these drugs again as more clinical trial results come filtering in.

While at the Farber on Tuesday, I read an interesting article in their "Inside the Institute" newsletter about a current study published in the journal "Nature Medicine" about the protein p53, known by the imposing name as the "guardian of the genome".  p53 responds to any mutations in cell DNA, such as happens with myeloma, and tries to shut down cell division or order the cell to commit suicide.  However, there is another protein called YAP1, which if it is not produced in sufficient quantity, prevents the p53 protein from doing its job.  Researchers in the Farber and Italy have found that production of YAP1 is controlled by an enzyme, STK4.  By silencing the STK4, YAP1 levels increase and the myeloma cells die, both in laboratory tests and in animals.  This is a novel strategy for treating MM patients with low levels of YAP1.  Farber chemical biologists are working now on developing such agents.  Obviously, this is a long way from an actual marketable drug, but this gives an indication of the intensive research that is now going on to fight MM.  Ken Anderson is a senior author and Paul Richardson is a co-author of this article.  It's good to know that the Farber is still on the cutting edge of this research.

I have to say that I am really encouraged by the amount of basic research being conducted, the number of new drugs being developed, the number of clinical trials available, and the rapid pace of new drug approvals by the FDA in the fight against MM.  It's all good.

Tomorrow, Jeff, Brian, Pam, Logan, Gretchen, and I head up to the farm in northern New York state for the weekend. It will be great to see our grandson, Logan, and I hope he starts to get an affinity for the homestead that was established by his great-great grandfather in 1881.






Monday, June 9, 2014

Belated Update

It has been two weeks since I have updated this blog, and I apologize for the hiatus.  I ask myself why I have waited so long to send a new post.  Today I drove to the Farber to attend the last session of the Writing Workshop for this academic year.  As usual, it was a wonderful and enriching experience.  Each of the attendees is either a cancer patient, survivor, or caregiver, and we have developed a strong confidential rapport amongst ourselves.  It's a place where we can express ourselves freely, both verbally and in writing.

Amy had a new challenge for us today, which had to do with interrupting one's writing for whatever reason.  It really hit home.  She gave us a prompt based on a poem by Tess Gallagher, who had recently lost her husband, the writer Raymond Carver.  Here it is:

I Stop Writing the Poem

to fold the clothes.  No matter who lives
or who dies.  I'm still a woman.
I'll always have plenty to do.
I bring the arms of his shirt
together.  Nothing can stop 
our tenderness.  I'll get back
to the poem.  I'll get back to being
a woman.  But for now
there's a shirt, a giant shirt
in my hand, and somewhere a small girl
standing next to her mother 
watching to see how it's done.

Of course, there is an oxymoron here...she stopped writing the poem in order to write a poem?

At the class, we were challenged to use the first line of this poem to write about something that we stopped doing for some reason in order to do something else for us to explain.  She gave us all 10 minutes to create something.  Everyone came up with an amazing response.  I can't believe how creative people can be with such a short time to respond.  As for myself, here is what I wrote:

I Stop Writing the Blog

to finalize the sale of our home.  I sit on the
back deck with the bittersweet feeling of both
relief and sadness.  I reminisce about all the beautiful
sunsets I've watched, the family and friend visits we've
hosted, and the many memories of these last ten years here.
I rush to finish fixing up what needs to be fixed, and now we
search for a new down-sized place to live, knowing that 
it won't compare to what we are leaving behind.  I'll get 
back to writing my blog.  But for now, I am overwhelmed
with this major passage in my life.

When I read this to the class, someone suggested that this could in fact be my next blog post.  So here is another oxymoron.  My excuse for not updating my blog becomes the update to my blog!  No wonder I love this workshop!  Too bad I have to wait until September for the next meeting.

Tomorrow I head back to the Farber for my monthly checkup and Zometa infusion.  I also have an appointment with Dr. Jean Marie Connors, a benign hematologist, to check whether my continued anemia might be related to something other than my MM.  This is just a cautionary appointment, but I'm glad that Dr. Richardson has reached out for another opinion.

Last Friday, we attended my 50th MIT reunion.  Here is a picture of me and my best long-term friends over this last half century:  Joe Kasper, Steve Roberts, and Bob Paltiel.  All of us except Bob were wearing our 50th reunion cardinal jackets, perhaps for the only time.  It was such a treat to have us all together for this event, and we proudly marched into the Killian Court ahead of the 2014 graduates to participate in the commencement ceremony.  It was a memorable event.

I do have some other myeloma-related items to share from the recent ASCO Conference and some recent Farber MM research, but I'll save those for another post.  It's all good!


Monday, May 26, 2014

Sold!

After more than a year of trying to sell our house, we finally did it!  We have agreed on all the terms with the buyer and plan to have a signed P&S agreement by tomorrow.   We were concerned about a couple of issues that arose during the inspection, but the buyer agreed to pay the full offer price.  It's a cash transaction, so there is no mortgage contingency to deal with.  In addition, she will allow us to stay here for several months at a nominal rent.  That's a huge benefit.  It relieves us of a lot of pressure and gives us some breathing room to pack, get rid of stuff, and, oh yeah, find a new home.

This is a huge weight lifted from our shoulders, but it is also bittersweet.  We have really loved this home over the past ten plus years, and we will definitely miss it.  However, it is much too big for just the two of us, and the carrying costs are more than we want to continue to bear.  It's time to move on.  We are hoping to find a smaller home that will meet our needs for years to come (I'm being optimistic in looking forward to "years to come").  I'm sure we will find the right place.  In mean time, we plan to enjoy our last summer on the river.

There has been some recent buzz about a potential new immunization therapy for MM using a genetically-modified measles virus.  Two heavily-pretreated patients were given the vaccine, and the results were dramatic.  In both patients, the MM receded dramatically, but after several months, the MM returned in one of the patients.  The media has played this up, but we all have to understand that this is nowhere near becoming a potential therapy in the near future.  What I think is most exciting about this is that it exemplifies the vigorous focus now being concentrated on finding ways of triggering the body's own immune system to fight cancer.  I recently blogged about this last month:  Immunotherapy Research.  There are a lot of promising developments in this arena, and I expect that there will be some significant breakthroughs in the next few years.  Here is a video by Dr. Ken Anderson of DFCI showing how excited he is about these new approaches:

immune-based therapies for multiple myeloma

There seems to be a sense of optimism among researchers that we may be on the threshold of some major advances in fighting all cancers, not just MM.  I am grateful that I continue to be in remission, which may give me time to take advantage of some of these new therapies as they become available.  I know it's only a matter of time before my multiple myeloma rears its ugly head again.



Thursday, May 15, 2014

Pin Cushion

Full Moon over Farm
I haven't updated this blog yet this week, since I spent from Monday to Wednesday up at the family farm in Champlain, New York with my son, Jeff, to open it up for the summer.   The Internet connections aren't so great up there, and besides, we were too busy having fun for me to worry about my blog.  The weather was great, and on Tuesday, we cooked porterhouse steaks over the charcoal grill for dinner (medium rare of course), and then sat around the fire pit smoking cigars, drinking beer, and just chatting.  It doesn't get any better than that!  It was a full moon, and the clouds scudding across the sky were breathtakingly beautiful in the moon light.  I took this picture with my iPhone, which kinda sucks, but Jeff got some really great pictures with his professional Canon camera.  I can't wait to see how his turned out.  Gallery quality, I would guess.  Alas, we had to come back yesterday so Jeff could pick up his girlfriend, Christine, at Logan Airport on her flight back from Paris.  (Most of our family have been world travelers lately going hither and yon!)  Short as it was, we still had a great visit to the farm.  It's always a relaxing, wonderful experience when we can get there.  We plan to head back up for the Fourth of July weekend.  Can't wait!

On my way to the farm, I went back to the Farber Monday morning to see if I had recovered from my cold and to check my numbers after a week without Revlimid.  It was all good.  My pathology results from last month still show no signs of monoclonal gammopathy (yay!).  The antibiotic prescription they gave me last week worked fine, so I was back in good health.  Interestingly, my white blood cell count (WBC) and hematocrit (HCT) both jumped back up into the normal range!  Wow!  My WBC was 4.1 and HCT was 38.8.  While my continued use of iron supplements has helped these numbers a bit, the most logical explanation for the big jump is that my week off the Rev really helped.  I have been worried about my continued anemia over the past several years, but these latest results give me some encouragement.  First, I think the iron supplements are slowly restoring my blood counts to normal.  And second, I think the Revlimid is responsible for a lot of my lower counts, even though I am taking the minimum dose of 5 mg/day.  I did forget to take my Rev to the farm, so I got an extra 2 days off.  My bad!  Anyway, I am now back on my normal daily regimen of Rev.  I also turned in a 24-hour urine sample on Monday, the first time since January.  The results have now come back showing no monoclonal protein in my urine (another yay!).  I couldn't be happier with my progress so far.  I consider myself extremely lucky.

I finally got my immunization shots, which have been put off for months because of a cold or forgetfulness or whatever.  Anyway, I got a full dose of five shots on Monday, three in my left arm and two in my right.  I felt like a pin cushion.  Here's what I got:  Polio, Pneumococcal, Hepatitis A&B, Hib, and DTaP.  The Hib is some kind of anti-meningitis vaccine, and the DTaP is the typical diphtheria, tetanus, pertussis vaccine given to all 2-year olds.  My new immune system is now two years old, so I guess it's time for me to get all these baby vaccines taken care of.  By the way, Heather, my favorite nurse, gave me the shots, and they didn't hurt at all, even though she hates giving them.  Only later in the day when I was up at the farm did I notice that my arms ached a bit.  No big deal.  I'm really used to being poked, prodded, and stuck by now.

Wednesday, May 7, 2014

Home Again

We got back Sunday from a whirlwind vacation to Ireland and Barcelona, Spain.  It was a great trip, and it was wonderful to spend time with two of our kids and their significant others.  It's too bad the whole family couldn't have been there, but alas, they all now have their own lives and commitments.

As you may know, I have Irish heritage, with my known paternal family roots going back to Co. Tipperary in the early 1800s.  However, I have not found any known relatives using conventional genealogy research.  Therefore, I have resorted to DNA testing to see if I can find some ancestral roots that way.  From my y-chromosome DNA results, I discovered that I am a descendant of the progenitors of the O'Brien clan in Ireland, with roots extending back to the time of Brian Boru, who was High King of Ireland a thousand years ago.  This year, Ireland is celebrating Brian Boru's victory at the Battle of Clontarf in 1014, which freed Ireland from the Viking invaders.


Rock of Cashel, Co. Tipperary, Ireland
One stop on our journey was the Dromoland Castle in Co. Clare, which used to be Brian Boru's castle. We then spent two days celebrating Holly's friend's wonderful Irish wedding.  After the wedding, we drove to the famous Rock of Cashel.  When we got there, they were celebrating the coronation of Brian Boru as the King of the Munsters, before he became High King.  It was a happy coincidence for Jeff and me to see this reenactment of a ritual that may have happened to an ancient ancestor of ours.

 Sagrada Familia, Barcelona
After touring Dublin, Holly & Ryan, Gretchen & I flew to Barcelona for 4 nights.  What a great city that is!  We had a chance to see the famous Sagrada Familia, the unfinished basilica by the famous architect, Gaudi. We also spent many hours walking around the old city with its Gothic architecture and narrow streets.  I was pleasantly surprised that I had plenty of energy for all this walking and my bum knee didn't bother me at all!  We ate well, and the tapas were delicious.  After a wonderful holiday, we all headed for home on Sunday.

After a short night's sleep, I went into the Farber on Monday for my monthly checkup.  Everything is still fine.  My iron levels are still low but are improving gradually.  Unfortunately, I picked up a cold while in Europe, so I still had some sinus and chest congestion on Monday.  Since the Revlimid inhibits the immune system, Mary and Muriel decided that I needed to stop taking the Rev for a week and gave me an antibiotic prescription to keep me from getting a secondary infection.  I have to go back next Monday to check my numbers again, and if I'm back to normal, I will go back on the Rev.  I still need to take some immunization shots, but they postponed them until next week as well.  Other than that, all is good.

Wednesday, April 23, 2014

Jet Setting

Tonight Gretchen and I are flying off to Dublin, Ireland to attend a wedding on Saturday.  Son Jeff and his girlfriend Christine are joining us on the flight over.  We will then drive from Dublin to Shannon tomorrow to pick up daughter Holly and her boyfriend Ryan, who will be coming in from San Francisco.

The bride is one of Holly's childhood friends.  The wedding will be in a quaint resort town called Coolbawn Quay, in Co. Tipperary, not far from where my paternal ancestors lived.  All of us will get in some touring of Ireland both before and after the wedding.  From there, Jeff and Christine are headed off to Turkey, while the rest of us go on to Barcelona, Spain for a few days before returning home on May 4.  We're all really excited about this trip!

This is our first major trip since Gretchen's accident, so we will have to take it a bit easy.  Despite my MM and her head injury, we are both fortunate to be able to travel and see the world.  We want to get as much of this in as we can while we are still able.

Needless to say, I won't updating this blog until I get back.  My next visit to the Farber is on Monday, May 5, so I should have some updated news to report then.  

Our house is going back on the market today.  We have hired a "stager" to change things around to make the house "pop".  This will all occur while we are away, so the house will have a new look when we get back home.  We're glad to have the house shown in our absence.  It's a real pain to have to keep everything in show condition while trying to live a normal life.  Hopefully, we'll get some nibbles while we are traveling.


Friday, April 18, 2014

Immunotherapy Research

I've been doing a little more research on the exciting new research direction of harnessing the body's own immune system to fight cancer.  One of the most promising areas of research involves activating the body's T cells.  I'm going to try to give a layman's explanation of this, which I hope is not full of you know what.  Bear with me here.

electron microscope photo of T cell
T cells are a type of white blood cell that are the immune system's strike force against foreign invaders and diseased cells.  Antigens from the cancer cells are collected by antigen-presenting cells (APCs) and then transmitted to the T cells, along with a trigger protein, B7, which tells the T cells to attack.  The T cells are then sent on a search and destroy mission against the cancer cells.  T cells have a protein receptor, PD-1 (aptly named Programmed Death-1), which allows them to destroy cells that they contact.  In order to keep the T cells from destroying healthy cells, all healthy cells have a protein co-receptor, PD-L1.  When PD-1 is bound by PD-L1, this turns off or deactivates the T cell, thus saving the healthy cell.

The T cells also have another protection against destroying healthy cells. A receptor called CTLA-4 on the T cell itself can prevent B7 from doing its job in order to “keep the brakes on” the immune system.

Now I'm going to turn to literature.  I just recently read John LeCarre's famous spy novel, Tinker, Tailor, Soldier, Spy.  In it, the British spy, George Smiley, battles his Russian spy nemesis, Karla, who has planted a high-level mole in the British spy network, MI5.  In this story, Smiley tries desperately to uncover the secret mole who is undermining Britain's defenses.

Here, the cancer is Karla, and the cancer researchers trying to unravel this mystery to protect the immune system represent George Smiley trying to protect Britain.  The cancer, like Karla, is brilliant, resourceful, and difficult to beat.  The cancer mole managed to penetrate the immune system.  It has essentially stolen the PD-1/PD-L1 mechanism from normal cells in order to evade attack by the immune system!  However, as with Smiley, cancer researchers are ingenious, dogged, and determined.  They have recently discovered this mole in our cancer defenses and are now mounting a counter attack.

PD-1 inhibitors have been developed and are now in clinical trials.  The graphic below shows the mechanisms for breaking the bond between PD-1 and PD-L1, allowing the T cells to continue on their search and destroy mission.  Other antibodies are also in testing to inhibit the CTLA-4 receptor on the T cells, allowing them also to proceed to attack the cancer cells.
 
How PD-1 inhibitors activate T cells against cancer cells

There is an interesting discussion of these research approaches along with some of the ongoing clinical trials at this website:  https://www.smartpatients.com/pathways/pd-1.  Some of the monoclonal antibodies, such as Nivolumab and Ipulimumab, are showing promising results in clinical trials.  So far, the most dramatic results have been for melanoma, non-small cell lung cancer and kidney cancer, but these results should be encouraging for MM research as well.

One of the interesting things about immunotherapy is that the results seem to last longer than the therapy itself.  Once the T cells have been armed with the immunization, the results seem to be be very durable, even after the treatment has been discontinued.

I hope I haven't bored you or overwhelmed you with technical stuff.  But I like to have a picture of what is happening in MM research and I'm very encouraged by this approach.  I was happy to notice that Dana Farber has been on the forefront of this research.  Dr. Gordan Freeman of DFCI led the discovery of the PD-1 protein.

It's all good.