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Monday, March 3, 2014

Bone Marrow Biopsy

This past week, I had a wonderful golfing vacation in Ocean Isle Beach, North Carolina.  Despite playing poorly and losing many balls in either the woods or the water during the week, it was a wonderful time...mostly good weather, great company, and awesome food. We got to play in shorts most of the week and only got rained out on one day.  What a nice getaway!  Being able to spend quality time with my son, Jeff, my brother, Terry, and my great friend, Bobby, was priceless.

The only glitch was that I inadvertently picked up the wrong laptop at the security checkpoint at Logan Airport on our way out last week.  I discovered the error before boarding our flight and returned the wrong computer to security, but mine was nowhere to be found.  I was able to send a message to my missing iMac from my iPhone to display my phone number to whoever opened it.  Fortunately, the person who had my computer got the message and called me after we got to Ocean Isle Beach, saying that he had it and would get it back to me.  Whew!  That lifted a potential cloud over my vacation.  To make a long story short, he retrieved his computer when he got back to Boston, and I finally picked up my laptop today from his home in Cambridge on my way to the Farber.  I've felt lost without it.  My computer is my blankey.  Now that I have it back, I can update this blog.

My visit to the Farber today was less fun than usual.  It was time for my annual bone marrow biopsy (BMB).  The last two years, I had Zach as the Physician's Assistant (PA) who performed it, which wasn't too bad.  This time, I forgot to ask specifically for Zach, so I got another PA instead.  She was really good (as they all are at the Farber), but the procedure still seemed somewhat more painful than I recall from the last time, so I must remember to ask for Zach again next year.  I'm still a little sore.  I have volunteered for them to take extra samples of my bone marrow to aid in scientific research, so that adds a little to the procedure.  It's worth it though, if I can contribute in any way to finding a cure for this pernicious disease.  This was still much easier than the first time I had a BMB performed by my original hematologist in May 2011 before my initial diagnosis.  That was a real ouch (I don't think he liked me)!  Anyway, I'll find out the results in a couple of weeks.  I'm keeping my fingers crossed that I am still in remission.  It's coming up on three years since my initial diagnosis, so I'm really happy with my condition right now.

My son, Jeff, noticed last week was that I was full of energy and able to get through all the rounds of golf with no problems.  I even played 27 holes on one day.  I only napped on the one day that we got rained out.  Despite all my knee problems a few months ago, it didn't bother me at all last week.  So looking back on it, I think I did OK.  Not bad for an old fart.

While at the Farber, I picked up the latest copy of their monthly news summary, "Inside the Institute".  The feature article by Nikhil Munshi, one of the MM specialists at the Farber, addressed the genetic diversity among MM patients.  The findings showed that MM in each patient is a jumble of cell clusters with different mutations.  Also, the disease is not consistent over time, with new mutations continuously forming.  From previous research, I already knew this was the case for those with the t(4:14) genetic abnormality, but apparently this is also true across the board.

Dr. Richardson was part of this research team.  Using DNA myeloma samples from 84 patients (I could possibly be one of them), they found that each tumor sample had an average of over 50 mutations, and no one mutation was found in every sample!  In some samples, the the type and number of mutations stayed relatively constant over time, but in others, mutations that weren't present at diagnosis became very common later on.

Much of the promising research these days is to use genomic information to find individualized targeted therapies to treat MM.  These latest results imply that this may be more difficult than first hoped.  MM appears to be a moving target, even within each patient.  How do you deal with this?

Putting a positive spin on these results, Munshi said, "We are at the cusp of the use of targeted therapies for myeloma.  This study makes it clear that such therapies will work best if they not only block critical mutations, but if they slow or stop the evolution of new and different mutations in the cells."

It seems obvious to me that despite recent advances, the medical community is still a long way away from developing individualized therapies for MM.  In the meantime, we can all take hope in the promising new drugs now in use and under development that seem to be working for a large segment of MM patients.  Keep the faith! 


  1. I wonder if you had the PA I had for my first BMB... Hope the soreness subsides soon and good luck with your results!

    1. Thanks, Elizabeth. I'm still sore today, but I'm sure it will subside soon.

    2. Bill, who did this bmb? (just initials is fine ;))

  2. Sounds like you had a painful time like my first BMB. Since than they are much better. I have had 6 so far and my wife prevented me in Sept. '13 from being tortured by a newby. We were sitting in the waiting room in Little Rock and heard this patient through the wall shouting and crying! I was heavily medicated and would not have cared if they had stabbed through me, but she watched and made sure it was "Bone Marrow Bob."
    Hope your results are great!

    1. Thanks, Keith. I will make sure next time to get my favorite PA to do my BMB.