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Tuesday, November 20, 2012

Maintenance Cycle 4 Start

Yesterday was my monthly visit to DFCI for blood work and Zometa infusion.  This is the Cycle that my Revlimid dose was supposed to increase from 10 to 15 mg/day.  However, the prescription I got for next month was only for 10 mg.  I was going to ask about this, but as you will see below, the question is now moot.

The blood test results could have been better.  My platelet count was a low 124 (normal is above 155) and my white blood cell count (WBC) has dropped to 2.2 (normal is above 3.8).  Of more concern was my absolute neutrophil count (ANC), which has fallen to 0.96 K/uL (or 960/uL).  Anything below 1.0 is considered to be moderate neutropenia.  This is not a good thing, as it leads to increased susceptibility to bacterial infection.  This is the threshold used for suspending treatment until the ANC recovers.

The last time this happened was when I was on the consolidation therapy back in July.  At that time, I stopped taking the Revlimid (as well as the Velcade and dexamethasone) for a week and took a Neupogen shot to stimulate the neutrophils.  When I resumed the Revlimid, the dosage was reduced from 15 mg to 10 mg/day for the remainder of the consolidation phase.  That experience is one of the reasons I have been concerned about Dr.  Richardson's plan to increase my maintenance dose to 15 mg after 3 Cycles.

The neutrophil results didn't come in until after my appointment with Dr. Richardson's nurse, Mary McKenney.  I saw the results online later, and I was going to call her today to ask about it, but she beat me to it.  Mary said to suspend taking my daily 10 mg dose of Revlimid for the next week.  She has scheduled me for another appointment next Tuesday to check my blood counts again.  If they are OK, the clinical trial protocol calls for reducing the Revlimid dose from 10 to 5 mg per day.  It looks like I won't have to worry about convincing Dr. Richardson not to increase my dose to 15 mg after all.

I was able to finish up my Zometa infusion in time to attend the monthly meeting of the Writer's Workshop at noon.  What a pleasant and enriching experience this seminar is!  I feel humbled to be in the presence of such intelligent, talented, creative, and interesting people, all of whom are dealing with serious cancer issues, either as patient or caregiver.  Most of them are very well read and talk about authors and books that I have never heard of.  It makes me feel quasi-literate at times.  At least I was the only one in the room who knew the definition of "stanchion", which was used in a poem we were studying by Ted Kooser.

The writing assignments are challenging, and most of the contributions are beautifully written.  I am already struggling with our next assignment.  The next meeting will be on December 10, which is not my normal appointment day at DFCI.  However, I plan to drive into Boston that day anyway just to attend the workshop.

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