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Thursday, June 12, 2014

Maintenance Cycle 23

It has been almost two years now into my maintenance therapy.  Tuesday I went back to the Farber for my monthly blood test and Zometa infusion.  I also met with Dr. Jean Marie Connors, a benign hematologist, to address my iron deficiency.  Her NP, Samira, collected all the medical information about me since I first noticed my anemia, back while I was exhausted trying to ski in Switzerland in December 2008 (I think).  I may have gotten some of my dates mixed up, but I recounted my persistent anemia, no matter what pills I took (Iron, B12), my long debilitating encounter with Lyme Disease (severe neck aches, a lost summer of chronic fatigue, fevers, chills, rashes, shooting pains, Bells's Palsy (twice), peripheral neuropathy, double vision, you name it), my arguments with my PCP about refusing to diagnose Lyme Disease, my escape to the wonderful naturopath, Dr. Mikulis, to finally diagnose and cure my Lyme disease, and my somewhat contentious relationship with the hematologist from Lahey Clinic who couldn't improve my anemia, finally leading up to his diagnosis that I had Smoldering Multiple Myeloma in May 2011.  What a nightmare those times were!  Of course, that's when I made a bee line for the Farber and was fortunate enough to get Paul Richardson as my oncologist, who diagnosed me with MM in July 2011.  Even though I now have MM, at least I know I'm getting the best care possible and I am happy with my current situation.

Dr. Connors noted that my iron levels have improved somewhat since December, when tests found them to be quite low.  She said that the Ferrex pills I am taking might take up to a year to return my iron levels to normal.  I  could make that happen faster by taking an IV infusion of iron, but I decided that as long as the trend is positive, I don't feel that I have to resort to extraordinary methods.  She agreed, so I got a new prescription to up the dose of Ferrex from 2 pills a day to 3, and I have an appointment in 3 months to see how that is working.

My blood test numbers this month continue to be good!  The pathology results from last month's serum and urine electrophoresis and immunofixation tests both show no M-spike and no monoclonal gammopathy.  So I continue to be in remission, which is wonderful.  All my other numbers were great, except for one.  My absolute neutrophil level dropped from 2.06 (normal range) to 1.09 this time!  Anything below 1.0 is cause to suspend the Revlimid, as it depresses the neutrophils, making me susceptible to infections.  That was somewhat of a surprise.  I now have to take another blood test in two weeks to see whether it has recovered or whether I have to take a hiatus from the Rev.  I'm taking the minimum dose of 5 mg/day, so I can't figure why this would be a problem.  Oh well.

There were some exciting new developments at the recent ASCO Conference.  I won't go into detail, but three new drugs are showing significant promise:  panobinostat, daratumumab, and SAR650984.  It's exciting to see that there is progress on multiple fronts in the fight against MM.  I'm sure I will be talking about these drugs again as more clinical trial results come filtering in.

While at the Farber on Tuesday, I read an interesting article in their "Inside the Institute" newsletter about a current study published in the journal "Nature Medicine" about the protein p53, known by the imposing name as the "guardian of the genome".  p53 responds to any mutations in cell DNA, such as happens with myeloma, and tries to shut down cell division or order the cell to commit suicide.  However, there is another protein called YAP1, which if it is not produced in sufficient quantity, prevents the p53 protein from doing its job.  Researchers in the Farber and Italy have found that production of YAP1 is controlled by an enzyme, STK4.  By silencing the STK4, YAP1 levels increase and the myeloma cells die, both in laboratory tests and in animals.  This is a novel strategy for treating MM patients with low levels of YAP1.  Farber chemical biologists are working now on developing such agents.  Obviously, this is a long way from an actual marketable drug, but this gives an indication of the intensive research that is now going on to fight MM.  Ken Anderson is a senior author and Paul Richardson is a co-author of this article.  It's good to know that the Farber is still on the cutting edge of this research.

I have to say that I am really encouraged by the amount of basic research being conducted, the number of new drugs being developed, the number of clinical trials available, and the rapid pace of new drug approvals by the FDA in the fight against MM.  It's all good.

Tomorrow, Jeff, Brian, Pam, Logan, Gretchen, and I head up to the farm in northern New York state for the weekend. It will be great to see our grandson, Logan, and I hope he starts to get an affinity for the homestead that was established by his great-great grandfather in 1881.

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