Seven four-week cycles of the phase-II trial of the new Celgene drug CC-4047 are now complete, and overall results are great. M-spike is unchanged this month at 1.0, but down from a high of 2.7 at the start of the trial. IgG is up a little but I have a cold which can make it go up, and Lambda free-light chains (FLC) are at the lowest level in five years of measuring them. Doctor L used the word "stable" to describe my myeloma. Stable is good.
White cell and red cell counts are mostly unchanged, also good. Blood pressure, which was about 150/80 last month, was down this month, probably because Dr. L reduced my dosage of dexamethasone (dex) from 20 mg once weekly to 12 mg. That 12-mg dosage continues for the ongoing eighth cycle. This is the entire protocol as prescribed by Dr. L:
- 2 mg CC-4047 every day, no days off. I take it at bedtime.
- 12 mg dexamethasone once weekly. I take it with Sunday supper, so Monday is "dex day" for me.
- 325 mg generic aspirin daily, to prevent deep-vein thrombosis (DVT). I take half in the morning and half with the CC-4047.
- 75 mg generic ranitidine (Zantac) twice on Sunday and once Monday morning, to mitigate stomach problems from the dex.
- 400 mg generic acyclovir daily, to stave off shingles.
| 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 | Best with a wide browser window. Very "technical." |
Side effects of the two key drugs, CC-4047 and dexamethasone, are discussed in a previous post.
Other subjects that came up:
- The side effects of dex are mostly reversible, except for cataracts. So far I haven't had that problem.
- Would lutein be of value in fending off cataracts? Curious minds want to know. Eat your Brussels sprouts.
- Every myeloma treatment works better with dex than without. Darn.
- The half-life of the IgG protein, whether monoclonal or normal, is four to six weeks (!).
- IgG is a measurement of all immunoglobulin G proteins, while M-spike measures only the monoclonal part of IgG.
- The half-life of light chains is two or three hours.
- Hence the light chains can be a more-current snapshot of what's going on, compared with IgG or M-spike.
- Events in the body can make light chains go up and down, but kappa and lambda normally go up and down together.
- The exception is myeloma, which makes one go up independently. This is why the ratio of kappa to lambda is useful.
- Celgene seems to be calling CC-4047 "pomalidomide" now. But it still says CC-4047 on the bottle of capsules that I get.
- Revlimid can cause thyroiditis, causing the thyroid to first become overactive and later become underactive (hypothyroid).
- Since CC-4047 could have a similar side effect, Dr. L checks my thyroid every three cycles. So far so good.
- CC-4047 appears to have much less effect on white and red cell counts than Revlimid, which can depress counts substantially.
| Test | Jun 26 | Jul 24 | Aug 22 | Sep 16 | Remarks | |||||
| M-spike g/dL | 1.1 | 1.1 | 1.0 | 1.0 | Best tumor measure | |||||
| IgG mg/dL | 1450 | 1330 | 1040 | 1180 | Variation is normal | |||||
| L FLC mg/dL | 4.03 | 3.30 | 3.57 | 2.64 | Free light chains | |||||
| Calcium mg/dL | 10.1 | 9.7 | 9.3 | 9.7 | Below 10.2 is best | |||||
| Creat mg/dL | 1.0 | 1.0 | 1.3 | 1.0 | Kidney, lower is better | |||||
| HGB g/dL | 14.8 | 14.3 | 13.8 | 13.6 | Hemoglobin, a bit low | |||||
| RBC M/uL | 4.28 | 4.17 | 3.99 | 3.90 | Red cell count, low | |||||
| WBC K/uL | 5.5 | 4.7 | 4.4 | 5.3 | White cells, normal |
Red cell count and hemoglobin are on the low edge. I will continue to try to treat those with sublingual B-12 for another month.
Meanwhile I'm still running and life is good.
Breakfast: Don't you love berry season? Still possible to get some good ones. There's oatmeal under there somewhere.
