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Thursday, April 5, 2012

Followup with Richardson

Yesterday we saw Dr. Richardson for a followup visit.  My numbers are looking good, and I didn't need to get another blood or platelet transfusion.  He was very pleased with my progress, and he reiterated how fortunate I am to be on the arm of the clinical trial that involves consolidation therapy followed by Revlimid maintenance for 3 years.  We exchanged high fives over that.

As for the confluence of events that led to me having the stem cell transplant now and for being selected for this arm of clinical trial, Dr. Richardson said it's like I bought the best possible insurance policy at the best possible time!  I can't think of how things could have worked out any better.  Any doubts I might have had about choosing this path have long-since vanished.

Here is how this whole thing seems to be shaping up.  I achieved a Complete Response (CR) from the MLN9708 clinical trial after 7 cycles, almost, but not quite, a stringent Complete Response (sCR).  However, there is a good chance that the chemotherapy and the ASCT might drive things further down so as for me to achieve sCR.  That, of course, would be the ideal outcome.  I should find out in 3 months.  However, even if that hasn't happened yet, the consolidation therapy of Velcade/Revlimid/dexamethasone (VRD) might do the trick.  Then, as an added bonus, I will go on Rev maintenance, which has been shown to be very effective in preventing relapse.  Serendipitously, Revlimid also has also been shown to be very effective at countering the high-risk t(4;14) chromosome translocation that I have.

This is what Dr. Richardson means by saying,  "Hit it as hard as you can as fast as you can".  I don't know how much harder or faster I could be doing this.  And I haven't sacrificed any future options by taking this path.  I still have stem cells in reserve for another transplant should that become necessary.  Because of my age, if I had deferred on the transplant at this time, I still would only have the option for a single transplant in the future.  So in retrospect, this was kind of a no-brainer!

It is well-known that MM patients who achieve sCR after ASCT have the best chance for a long-term remission, with a Median Time to Progression (TTR) of 5 years or more.  Of course, I'm not a statistic, so who knows how long my remission may last?  Months?  Years?  Right now, I'm optimistic that I may be able to enjoy a nearly normal life for years into the future.  And what about when the MM returns (as it must)?  By then I hope more medical miracles will have come to pass that will help me back into remission again, or even cure this damnable disease! 

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