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Monday, April 7, 2014

Maintenance Cycle 21

Today was my Farber day.  Fortunately, my numbers continue to look good.  My neutrophils were at 1.76, a little below normal but still well in the range for me to continue on the Rev maintenance.  My hematocrit (HCT) actually went up to 37.9, the highest reading since I was diagnosed back in 2011!  That's good news.  Last month it was at 34.8.  Maybe the iron pills I've been taking for the last three months are having a salutary effect.  I'm still anemic, of course, but other than getting tired easily, I feel really good.  I'm not ready to run the Boston Marathon, mind you, but I can still take a fast walk to my mailbox.

In other news, my knee is still feeling good from my meniscus tear and osteoarthritis.  The cortisone shot I got in September seems to be still working, which is great.  I have been a little lax about getting to the gym to follow through on my PT exercise regimen.  However, I had to get out of the house Saturday because Gretchen was hosting a "Goddesses" get together with her women friends.  Not a place I wanted to be, and the feelings were quite mutual.  I just had the excision surgery for the squamous cell skin cancer on my arm on Wednesday, and I was told not to do anything for a several days (like bend over, etc.) because of the stitches.  Yeah, right!  As a sop to Molly, the surgeon, I decided to forgo my upper-body exercises, but I did 30 minutes on the bike and then just worked on my leg muscles.  It must have been OK, because I didn't start bleeding to death afterwards.  Oh yeah, and I think I did bend over a couple of times.  Sorry, Molly.

There is lot of exciting recent news on alternative approaches to treating MM.  Up until now, the standard therapy approach consists of a multi-drug combination including a proteasome inhibitor, an immunomodulatory (IMiD) drug, and a steroid (dex).  While these classes of drugs are continually being improved (e.g., Kyprolis, MLN-9708, Pomalidomide), this new research is looking outside the box in the hopes of finding the Holy Grail of cancer treatment leading to a cure, not just remission.

Today's blog by Pat Killingsworth featured recent research results using T cell and vaccine immunotherapy.  Here is a link to his post:  T cell therapy is a way to use a patient’s own immune system cells to target and eliminate myeloma cells, either by waking up and empowering T cells through engineering (called CAR T cells)  or using a vaccine to stimulate the T cells to do their job.   One of the vaccines being studied is  nivolumab, which can release the brakes on an immune system attack on cancer. The drug blocks PD-1, a protein on the immune system T cells that restrains them from leading an assault on tumor cells.  (By the way PD stands for programmed death...great name!)  By interfering with the PD-1, nivolumab allows the attack to proceed.

In today's issue of "Inside the Institute" that I picked up at the Farber, there was a summary of a recent article in the "Journal of Clinical Oncology", which showed remarkable results using nivolumab in patients with advanced melanoma.  Hopefully, some of the clinical trials now underway for MM patients will show similar results.  By the way, considering my proclivity for various types of skin cancer, I'm heartened by the good results shown using nivolumab for melanoma. You never know.

It's a race against time.  Will they finally find an effective treatment for MM while I'm still around to benefit from it?  I'm very optimistic that they will.  Cheers.

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