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Monday, October 1, 2012

Biopsy Followup

In my penultimate post, I reported on the results of my recent bone marrow biopsy, which included Multiparameter Flow Cytometry (MFC) results.  The MFC test can determine whether there are any measurable MM cells in the bone marrow.  The test is much more accurate than the standard blood serum immunofixation test.  If no MM cells are detected by MFC, it indicates that there is no more than one myeloma plasma cell for every ten thousand normal cells. A negative MFC result is called an Immunophenotypic Response (IR).  Say that fast 6 times.  I know that sounds like a big word, but it has only half as many syllables as supercalifragilisticexpialidocious.

I was pretty excited to find that I have now achieved IR, which is a deeper response level than CR or sCR.  Of course, it's obvious that the better the response level I achieve, the better prognosis I am likely to have.  The question, however, is how much better?

Investigators have been analyzing this question, and there are several important published results.  One particularly relevant 2008 study by Bruno Paiva et al tracked MM patients who had an initial induction therapy using novel agents followed by autologous stem cell transplant (ASCT):  Their conclusion was that "Multiparameter flow cytometric remission is the most relevant prognostic factor for multiple myeloma patients who undergo autologous stem cell transplantation".  

The results were dramatic.  Those that did not achieve IR had a median Progression Free Survival (PFS) of 37 months, while the IR group had a PFS of 71 months!  Furthermore, the median Overall Survival (OS) was 89 months for the non-IR patients, but still had not been reached after 10 years for the those who had achieved IR. (That means that more than half of them were still alive after 10 years.)

All of this sounds very encouraging for me, but there is a fly in the ointment or turd in the punch bowl (take your pick).  This same researcher also published a subsequent paper that analyzed the effect of both IR and high-risk cytogenic abnormalities on Progression Free Survival after stem cell transplants:
 One of the high-risk cytogenic abnormalities included was my t(4;14) translocation.  These results were not so encouraging.  They showed that even for those who achieved IR after transplant, high-risk patients were likely to relapse much sooner than normal-risk patients (2-3 years vs. 6 years).  The recommendations from this study were that high-risk patients should consider consolidation therapy following transplant.

Well, that's just what I did, and I am planning to continue maintenance therapy as well, which I hope will mitigate the high-risk effect of my t(4;14) translocation.  The known fact that Revlimid seems to contain the risk of the t(4;14) abnormality gives me some hope that I might still achieve a prognosis similar to those with a normal risk.  It remains to be seen.

In any case, I have decided to spend less time analyzing this and more time enjoying my life in remission.  (I can already hear the collective sigh of relief from my readers.)  So tomorrow, I'm going to go play golf.  Fore!



  1. Bravissimo, Guillermo! We are encouraged by your latest test results and hope you have a long life after all your efforts to corral this disease!
    Salutationi d'Italia (Sorrento this week)!
    Susanna e Stefano