Thursday, February 9, 2012

Mixed Results

End of the 51st Cycle of Pomalidomide (CC-4047):

As often happens, some of the myeloma blood markers are up this month, some down. M-Spike is down from 1.2 to 1.1 g/dL, but IgG is up from 1190 to 1280 mg/dL. I don't know which to believe, so I'm calling it a draw, meaning "stable" in cancer lingo. For good measure, Lambda light chains are down from 2.24 to 1.99 mg/dL, while Kappa chains went up, making the ratio go up, which in my case is good. I think. Maybe. As Dr L said, "We'll take it."

I take a little capsule containing 2 mg of pomalidomide every night, and every 28 days my family and I drive the 80 miles to Mayo Clinic in Rochester, where I have blood tests and the occasional ECG or X-ray. Next month will mark four full years on the pomalidomide study. I'm a satisfied customer!

Some of the discussion with Dr. L:
  • A previous doc at Mayo had given me a prescription for bactrim, an antibiotic, to be taken daily to ward off a pneumonia which attacks people with compromised immune systems. Dr. L gives the same prescription for people in my situation when dexamethasone (DEX) is part of the regimen, but not otherwise, and I am no longer taking DEX, so she did not renew the prescription. OK, the fewer medications the better.
  • I mentioned to Dr. L that the neuropathy in my fingers is slowly advancing. For example, I recently felt a suspicious blueberry between thumb and forefinger to see if it was soft or firm, but I couldn't tell without picking it up to check it more closely. She asked if I had tried acupuncture, and remarked that a few of her other patients seemed to have some success with it. I might try it, but right now the neuropathy doesn't really affect my quality of life. Yet.
  • Calcium was up again, slightly above the reference level. Dr. L thought it might be due to slight dehydration, especially since my blood draw was at 10 am rather than the usual 6 am and I can't take fluids until the blood draw. I think that's probably right. Anyway I have a skeletal survey and a bone density test scheduled for next month, so if the calcium is an indicator of bone loss, there is a pretty good chance of catching it.
Peripheral Neuropathy (PN):

The International Myeloma Working Group (IMWG) recently issued Guidelines for the Management of Treatment-Emergent Peripheral Neuropathy in Multiple Myeloma. This is a very comprehensive document which I recommend to anyone dealing with neuropathy caused by myeloma treatments. It discusses drugs, supplements, physical therapy, acupuncture, chemotherapy dose modification, and even prevention of PN. It's a guide for both doctors and patients.

If that link doesn't work, use this one, a verbatim copy of just the document on another web site.

Some Recent Test Results:

Test    Nov 17    Dec 14    Jan 12    Feb 07     Remarks
M-spike g/dL 1.1 1.1 1.2 1.1 \ Tumor marker
IgG mg/dL 1280 999 1190 1280 / Tumor marker
Lambda mg/dL 2.12 3.15 2.24 1.99 L Free light chains
Calcium mg/dL 10.3 10.3 10.0 10.2 High
Creatinine mg/dL 1.1 1.1 1.0 1.0 Kidney, OK
HGB g/dL 15.0 15.1 15.1 15.2 Hemoglobin, OK
RBC M/uL 4.18 4.17 4.36 4.18 Red cells, low
WBC K/uL 5.3 4.8 4.8 4.5 White cells, normal
ANC K/uL 1.70 1.90 2.40 1.70 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.

Oatmeal pancake. Might even be a bit of maple syrup on it: