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Tuesday, September 6, 2011

Cycle 1 Preliminary Results

When I began Cycle 2 of the clinical trial last week, blood and urine samples were collected to assess the efficacy of the treatment protocol after the first cycle.  Most of these results have come in by now, and I have been able to access them online through the DFCI Patient Gateway.  I haven't had a chance to discuss the results with my medical team, so I don't have an authoritative assessment as to what they mean, but I think they pretty much speak for themselves.

The number I was most anxious to check was the IgA level.  This is the amount of malignant monoclonal protein cells in my blood.  As of August 1 (beginning of my treatment), this level was 3180 mg/dL.  The fact that it had exceeded the threshold of 3000 was one of the reasons I was diagnosed with MM rather than smoldering myeloma.  Normal values for IgA range from 70-400 mg/dL.  As of August 30, my IgA level was 659, a drop of nearly 80%!  Needless to say, I was ecstatic.

Similarly, the total protein in my urine had dropped to 60 mg/24hrs from 392 on August 1, a drop of 85%.  Normal levels are <102.  That's got to be good, right?

All antibody protein molecules consist of both a heavy chain (usually IgA, IgM, or IgG), coupled with a light chain (either kappa or lambda).  My MM is classified as IgA Kappa, which means I have an overproduction of the kappa light chains.  One of the tests measures the Kappa/Lambda ratio, which normally ranges from 0.26 to 1.65.  On Aug. 1, this ratio was 578.6!  On Aug. 30, it was down to 26.6, a reduction of 95%.  The excess of kappa chains also retards the normal production of the lambda chains.  Normally, lambda free light chains are in the range of 5.7-26.3 mg/L.  During the Cycle 1 treatment, my level went up from 0.98 to 2.03, still low, but certainly in the right direction.

The other two quantities I was interested in were beta-2 mcroglobulin (B2-M) and albumin levels.  These two numbers form the basis for the International Staging System for Multiple Myeloma, which is used to predict estimated survival and treatment outcomes.  The normal range for B2-M is 0-2.7 mg/dL, and for albumin, it is 3.7-5.4 g/dL.  The clinical criteria for Stage I  MM (the mildest stage) is B2-M < 3.5 mg/dL AND albumin >= 3.5 g/dL.  As of July 20, my B2-M was 3.9 (gulp!), but was down to 3.3 on Aug. 1.  Albumin was 3.5 on Aug. 1.  As you can see, I was right on the hairy edge of Stage I vs. Stage II MM at that time.  As of Aug. 30, B2-M had dropped to 1.9 and the albumin had increased to 3.8, both in the normal range.  That's pretty good too, right?

I'm not in a position to draw too many medical conclusions from this data, but I don't think it takes a rocket scientist (or a hematologist oncologist) to conclude that these results look pretty damn good!  Like I mean AWESOME!!!  Needless to say, we are greatly relieved right now.  I hope to get some clarification from my medical team about these results in the near future, but I thought I would share this raw data now.

I'm sure glad my initials are W.O.

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