Maintenance Cycle 18

I have now made it almost a year and a half on my maintenance schedule following my ASCT.  So far, so good!  My blood tests at the Farber last week confirmed that I am still in remission.  I also submitted a 24-hour urine sample for the first time in 4 months, and that also showed no monoclonal gammopathy.  If I can make it another 18 months without a relapse, then I can go off all medications.  That's something to look forward to, but I don't want to get ahead of myself.  I'm just going to take this month by month.

Everything else seems fine except for one thing.  Based on my continued anemia, I had an iron blood test done last week.  The results weren't great:

                    Test                                                 Result                        Normal Range

                    Iron                                                        24                                49 - 181                                Total Iron Binding Capacity (TIBC)      507                              250 - 450
                   Ferritin                                                    10                                 20 - 400

As you can see, I'm definitely iron deficient.  The puzzling thing is that men don't usually lose iron that much, especially red meat carnivores such as myself.  In fact, I just devoured a 12 oz. slab of prime rib for lunch today.  Yum!  And as Popeye would say, "I eats me spinach".  Only 3% of men suffer from iron deficiency, usually caused from some source of bleeding.  So Mary and Muriel asked me whether I have had any excessive bleeding.  No, not that I have noticed.  There are several things that could cause excessive bleeding, such as for instance, colon cancer!  That was a scary thought.  I then remembered Dr. Richardson telling everyone at last year's Patient Symposium to get a colonoscopy because of the secondary cancer risk from Revlimid.

My memory being what it is, I couldn't remember how recently I had undergone a colonoscopy.  They are unpleasant enough that you'd think I'd remember, but duh!  Anyway, afterwards I was relieved to find out that I had one just this past April (thanks to Dr. Richardson's prodding), and the results were great--no polyps found.  I really should have remembered that, especially since I even blogged about it at the time.  But no.  In any case, that set my mind at ease on that score. 

Anyway, I am now on iron pills.  I am taking 150 mg of Ferrex twice a day.  It will be interesting to see if this helps to improve my chronic anemia and gives me a little more energy.  I'll get tested again in a couple of months to see if there is any improvement.

Last month, I posted an update on the Patient Symposium at the Farber.  I included some results showing a need for more aggressive treatment of Smoldering Multiple Myeloma (SMM) based on several clinical factors.  I just read an interesting abstract published in this month's issue of Blood, which expands on this topic.  Here is a link:

 http://www.practiceupdate.com/journalscan/7534?elsca1=emc_enews_expert-insight&elsca2=email&elsca3=practiceupdate_onc&elsca4=oncology&elsca5=newsletter

The bottom line is that using gene expression profiling based on a 70-gene signature can independently predict those SMM patients who have a 67% chance of progressing to active MM within 2 years.  So a lot of progress is being made on determining which patients with SMM are candidates for early intervention.  This type of screening will soon make it into the main stream and may lead to improved outcomes for those who can be diagnosed early.