Consolidation Therapy - Cycle 1 Day 1

Today was the reprise of my abortive attempt to begin consolidation therapy two weeks ago.  This time the paperwork was in place so there were no hitches.  Dr. Richardson was only an hour and a half late for the appointment this time, so today seemed to proceed at a rapid clip, relatively speaking.

My blood work came back pretty good today.  My white blood cell count is a little low, but my neutrophils are OK, so that's not a problem.  My bilirubin is a little high (measure of liver function), but nothing to worry about.  (Maybe I shouldn't have had that extra glass of pinot noir last night.)  On the good side, my total protein and albumin are back in the normal range, my anemia (RBC, Hgb, HCT) is improving, and my platelets are fine.

Claudia and Muriel both think I am doing well and I can relax most of the constraints on my diet and activities now.  I should still be a little careful doing yard work that raises a lot of dust and spores (e.g., mowing).  As for diet, I should still avoid eating raw fish, undercooked burgers, and salad bars (where people can slobber over the food and double dip).  Other than that, I think I'm OK to lead a normal life.  I even got permission to eat popcorn! Now I can enjoy going to the movies again.

One of my fellow MM patients just sent me a prepublished version of a paper which is appearing in the latest issue of the journal Blood regarding clinical issues with high-risk MM, including t(4;14).  One of the reasons these cases have poor prognoses and are so hard to treat is that there can be multiple malignant clones that mutate and change in dominance, so that suppressing one of them may allow another to flourish.  I could only understand about every third word in this paper, but I kind of got the gist of the overall concepts.  I took a copy of the paper in to show Dr. Richardson today to get his opinion.  It turns out he hadn't read it, since he hasn't gotten his current issue of Blood yet.  He was appreciative that I brought it to his attention.  (I have to admit I got a real kick out of showing him a technical paper he hadn't read yet.)  I let him keep my copy.

As it turns out, he recently met the author of this paper, whom he respects.  Richardson has also published on this topic, and he is quite aware of these clinical issues with multiple clones.  He told me that is why he thinks this arm of the transplant clinical trial I have been randomly assigned to, which involves RVD consolidation therapy, is the best one for me, because it brings multiple agents to bear to suppress any remnants of the disease, just what may be needed for my high-risk situation.  He didn't say those exact words, but I am paraphrasing what I think he meant.

The ASCO Conference in Chicago has just concluded.  You may have been reading a number of cancer-related stories in the national news over the past few days, most of which have come out of this major conference.  There were several MM sessions which showed some good progress on a number of fronts.  I was particularly interested in the ML9708 trial that for newly-diagnosed patients that I participated in. The results to date look good:  "Of the 46 patients who have completed four or more treatment cycles, 98 percent have achieved at least a partial response to the treatment regimen.   Specifically, 26 percent achieved a complete response, 20 percent achieved a very good partial response, and 52 percent a partial response."  I am still very grateful that I am one of the ones who achieved a complete response.

There continue to be advances in other drug therapies for MM, including carfilzomib (Kyprolis) and pomalidomide, both of which may be nearing FDA approval.  Another area with exciting progress involves the use of monoclonal antibodies, which can specifically seek out the myeloma cells and attack them without affecting normal cells.  One of these, elotuzumab, has shown particular promise and is already in late-stage clinical trials.  Progress is also being made in developing a myeloma vaccine, which is now in a clinical trial.  The good news is that there is a lot of research going on and a lot of trials underway to bring a number of new weapons into the battle against MM.

I remain hopeful and optimistic.