You might say, 'Why don't you take a sleeping pill?". Well, I'm a bit loath to add yet another pill to the impressive array I already take every day, enough to choke a good-sized horse. The sleeplessness usually only lasts one night, so I can live with it. Actually, I should get outside with a flashlight and work on some of those house projects.
It's a good thing I'm on a protocol that calls for low-dose dex (40 mg, once a week). Prior treatment regimens used to call for high-dose dex. I really feel sorry for those poor blokes. If I were on high-dose dex, I would have been out in the treetops in our yard last night, swinging from branch to branch.
While we were at the recent Patient Symposium, one of the doctors mentioned a patient requesting to get off the dexamethasone. Another of the panelists jokingly questioned whether it was the patient or the family members making the request.
I promised to explain the MM response criteria in my last post, so here it is if you can decipher it:
International Myeloma Working Group uniform response criteria
|Category Criteria ______________________________________________________________________|
|Stringent complete response (sCR)||CR as defined below PLUS: |
Normal SFLC ratio, AND
Absence of clonal plasma cells in marrow by immunohistochemistry or flow cytometry _____________________________________
|Complete response (CR)||Negative immunofixation on the serum and urine, AND |
Disappearance of any soft tissue plasmacytomas, AND
≤ 5% plasma cells in bone marrow ______________________________________
|Very good partial response (VGPR)||Serum and urine M-protein detectable by immunofixation but not on electrophoresis, OR |
≥ 90% reduction in serum M-protein plus reduction in 24h urinary M-protein by > 90% or to < 100 mg/24h _________________________________________
|Partial response (PR)||≥ 50% reduction of serum M-protein, AND |
reduction in 24h urinary M-protein by ≥ 90% or to < 200 mg/24h, AND ≥ 50% reduction in the size of any plasmacytomas present at baseline _________________________________________
|Stable disease (SD)||Not meeting criteria for CR, VGPR, PR or progressive disease __________________________________________|
|Progressive disease (PD) ||At least ONE of the following:|
> 25% increase in serum M-protein in 3 months (absolute increase must be > 5 g/L), OR
> 25% increase in urine M-protein in 3 months (absolute increase must be > 200 mg/24h), OR
> 25% increase in bone marrow plasma cell percentage (absolute percentage must be > 10%), OR
Development of new bone lesions or soft tissue plasmacytoma, OR Development of hypercalcaemia