Fly in the Ointment

So far, I've been very happy with my progress on this clinical trial. However, as one might say, there is a "fly in the ointment".

Now that's a phrase I've used unthinkingly for most of my life, but what does it mean, really? On the surface of it, it doesn't seem to make much sense, right? Where did this phrase come from? The answer appears to be Biblical. According to Wikipedia, the likely source is Ecclesiastes 10:1: "Dead flies cause the ointment of the apothecary to send forth a stinking savour." Now I get it! I'm glad that's settled. But I digress.

I got my Cycle 2 blood serum and urine protein electrophoresis results today. The urine results still show no m-spike, which is great! However, the serum results got a little worse from the last cycle. The previous result showed a "faint M-spike that is not apparent on the electropherogram and, therefore, cannot be quantitated". The latest result, however, shows an M-spike of 0.1 g/dL. That's still lower than the 0.29 g/dL that I had back in October, but it's going in the wrong direction! 

It could be that the 20-day hiatus from Dana Farber that I was forced to take due to Covid might have slowed down or reversed the progress of the treatment. I don't know. I hope that's the case and that this is just a temporary glitch.

But that's not the only problem! I just recently noticed from my October 13 bone marrow biopsy results that in addition to my known t(4;14) and hypodiploidy cytogenetic abnormalities, I also now have chromosome 1q amplification, or amp(1q).  This abnormality must have been acquired at some point, as it wasn’t noted in my previous bone marrow biopsies. It's not unusual for genetic abnormalities of MM patients to evolve over time.

On researching this, I quickly discovered that amp(1q) is associated with severely adverse outcomes for MM. Oops! Now that's a bummer. Nothing that I have read about it yet is very encouraging. None of the MM drugs in clinical use today seem to have any beneficial effect on amp(1q).

However, these projections seem to fly in the face of the good results I have been getting so far in my clinical trial. I was a bit bewildered, so I decided to email Dr. Richardson to get his take on this.

As is his wont, Paul responded promptly. Here is his assessment: "I would suggest this genetic profile in your disease validates the treatment we have recommended as this does suggest higher risk disease, but I am very hopeful we are going in the right direction with your treatment, which is designed to deal with just such additional “risk”."

Hmmm. That's not exactly a ringing endorsement, but I guess that's the best I can hope for. Maybe my long string of extraordinary good luck with MM is about to be tested. I have to say that these recent revelations have been like a "bolt from the blue".

Now that's another phrase I've often used without exactly understanding its meaning. I thought it might refer to a bolt of lightning. However, as it turns out, an ordinary bow shoots an arrow, but a crossbow shoots a projectile called a bolt. Since a crossbow has a lot longer range than a bow, the bolt can seem to come out of nowhere. Okay, that settles that. But then again, I digress...