Friday, December 17, 2010


IgG and M-spike both dropped 17% in the last 28 days, more than offsetting the increase of last month, and returning to levels that are typical of the stable plateau of the last two and a half years or so. Still on the pomalidomide (CC-4047) trial, I'm a happy camper. Please enjoy a beer for me.

Why did it go down? The better question is, why did it go up last month? Maybe because at that time I was recovering from two different virus infections and probably a related bacterial infection, and also had quite recently received my flu shot, the Magnum Jolt version for seniors.

Interesting: If it's true that IgG went up last month because of challenges to the immune system, then M-spike must have gone up for the same reason. Indeed, it's possible that the entire increase in IgG came from the M-spike component of IgG. Why would M-spike respond to challenges from intruding organisms? The answer is way above my pay grade.

Neutrophils: Again I had the CBC done at the local clinic on the afternoon before the visit to Mayo, because my neutrophil count seems to be much higher in the afternoon than in the morning. Also, just before the blood draw, I run up four flights of stairs and do some pushups, trying to squeeze out a little adrenaline, which is thought to tease the neutrophils out of their hiding places. Absolute neutrophil count was 2.5 K/uL, well into the normal range and WAY above the cutoff threshold of 1.0. Yay.

Discussed with Dr KDS:
  • We agreed that I'm still stable on pomalidomide as a single agent. I won't change anything.

  • A recent study has (finally!) shown that Zometa, one of the bone-building bisphosphonates, actually has a modest anti-myeloma benefit in addition to its bone-strengthening ability, improving both the average time to disease progression and the overall survival of study participants. Doctors are still getting their heads around this, but one possibility for some patients is Zometa once every month! Zometa can have serious side effects, though, including unusual and disabling fractures, and osteonecrosis of the jaw, so it is not an automatic prescription.

  • Two more studies, evaluating the use of Revlimid as maintenance therapy after stem cell transplant, showed that patients in the Revlimid arm of the study developed more secondary cancers than those in the placebo arm. Numbers were small, however, with less than 3% in both arms together developing a secondary cancer. Both studies, by the way, also demonstrated that maintenance therapy improved time to disease progression, but neither showed a clear improvement in overall survival.

  • Recent evidence suggests that my immune system may not be as strong as I have though it was. Three different virus infections were defeated only very slowly. Dr KDS is concerned that I could contract an opportunistic fungal infection called pneumocystis pneumonia, common with AIDS patients who may also have compromised immune systems. She prescribed a sulfa-based antibiotic called trimethoprim-sulphamethoxazole, brand name Bactrim, to be taken every day as a prophylactic treatment to prevent that pneumonia and any number of other bacterial and fungal infections.

    There is a slim possibility of myelosuppression, however, which means low red and white blood counts; HELLO I already have that from the pomalidomide. It can also, rarely, cause liver or kidney failure, a potentially fatal complication. I hadn't heard of Bactrim prophylaxis before, but Dr KDS said that it has been used without incident by other patients in my situation. She knows that I will study this stuff and do my best to balance the risk of pneumonia against the risk of side effects, before making a decision. She also gave me an order for liver and kidney function tests which I can have done after trying the antibiotic for a week or two. Perhaps I'll talk to Dr B, my new PCP, about this.
Some Current Test Results:

Test    Sep 23    Oct 20    Nov 18    Dec 16     Remarks
M-spike g/dL 1.2 1.1 1.2 1.0 Best tumor measure?
IgG mg/dL 1070 1130 1300 1080 Best tumor measure?
L FLC mg/dL 2.58 2.78 2.92 2.41 L Free light chains
Calcium mg/dL 10.0 10.0 10.3 9.8 Below 10.2 is OK
Creat mg/dL 0.9 1.0 0.9 1.0 Kidney, OK
HGB g/dL 15.8 14.9 15.0 14.6 Hemoglobin, OK
RBC M/uL 4.43 4.31 4.26 4.23 Red cells, marginal
WBC K/uL 4.2 4.3 5.9 5.1 White cells, OK
ANC K/uL 1.60 2.14 2.30 2.50 Neutrophils, normal!

Related Links:

My Myeloma     A discussion of my myeloma, not very technical.
My Treatment History Not technical.
My Test Charts Graphic displays of several key test results over time.
My Test Result Table Somewhat technical. Best with a wide browser window.
My Supplement Regimen With links to where I buy them.



  1. This is great news.

    I believe your diet and physical activity also contribute to holding the MM at bay. These, in consort with your positive attitude create a formidable first line of defense that allows the pomalidomide to perform.

    Happy Holidays!

  2. I wonder if the immune system triggers that cause the immune cells to increase and increase their production of immunoglobulins also cause the cancerous immune cells (myeloma cells) to increase and increase their secretion of proteins that make the colonial immunoglobulin.

    How much of the 1080 mg/dL of IgG is your m-spike of 1.0 g/dL? Mathamatically this indicates your good IgG would only be 80 mg/dL which I don't think is true. What is the level of your IgA and IgM?

  3. Hi Jerry,

    I suspect that the "good" IgG is actually only about 80 mg/dL, maybe a little more. Over the last 37 visits to Mayo, the average difference is 143 mg/dL.

    One of the comparisons was actually negative, though, with IgG at 1070 mg/dL and M-spike at 1.2 g/dL. I think that SPEP at Mayo Clinic may be a little too sensitive.

    IgA is 37 mg/dL, and IgM is 18, about where they always are.

    One engineer to another, eh?


  4. Your posts should be required reading for residents in oncology and immunology!

    It is great good news that your numbers are back in line.

    I am not an immunologist, not even a medical student or doctor. But some time ago I had an exchange with a doctor of immunology and I suggested that all cancers seem to 'feed' on various glucogens (sp?) and that patients who reduce the load of food items that have high amounts (like white flour, sugar, white potatoes, etc.) along with significantly reducing consumption of processed foods might do better in their recovery.

    He said he was interested in this theory and was going to see if he could get funding for a clinical trial using those parameters. I don't know if he ever did - this was two years ago - but seeing your wonderful photos of what you eat, I kinda think you might be proving this theory correct.

  5. I am feeling a bit dull this is probably a dumb question that I will live to regret ;-): How do you calculate your good IgG? Thanks!
    Really super news, Don. And just in time for Xmas, too! I am very very happy for you. :-) Buon Natale!

  6. Good news!

    Having just switched to Zometa for the anti-myeloma effect I'll be keeping my eye out for unusual and disabling fractures! ;D

    Further to Jerry's point I remember reading in some Myeloma UK literature about not taking echinacea - I wonder if that's for that reason.

  7. Hi Margaret,

    As far as I know, IgG by immunofixation measures both the good IgG and the monoclonal IgG, so to get the good stuff you simply convert IgG and M-spike to the same units and subtract M-spike from IgG.

    Hi Feresaknit:

    I've heard that a person should only start being concerned about Zometa if they have been taking it for more than two years. By then we'll probably know more about it :-)

    Meanwhile, enjoy the anti-myeloma effect!

  8. This is pretty cool. I opened not one, but two beers for you. Best, Peter

  9. Don-,

    found a great myeloma doc form a lab who is talking about 2011. Perhaps interesting for you? I would be proud if you would feature it and go deeper into it:

    Thanks for your blog!!!