But the news isn't quite as scary as it sounds. First, a small increase in M-spike doesn't necessarily mean that the bottom has been reached - we have seen M-spike go up before and then come back down again. It's happened twice already this year. Second, the increase in IgG could be due to an immune-system response to some sub-clinical invader in my body. In fact this seems fairly likely, because my white count and neutrophils are up slightly from last month and eosinophils are through the roof. Something may be going on besides myeloma at the moment.
Bottom lines:
- I'll have to wait another month to see if M-spike is really turning upward again. I sure hope not - it would be wonderful to get a nice, long ride from pomalidomide, because the drug regimen is relatively easy to take. When it fails, I will no doubt need to switch to something with more side effects.
- This uptick in M-spike coincides exactly with a reduction in the DEX dosage from 8 mg to 4 mg once weekly. So my hopes of going off DEX in the upcoming cycle are null and void. In another 28 days we'll see.
| 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." |
Some recent test results:
| Test | Jun 25 | Jul 23 | Aug 20 | Sep 17 | Remarks | |||||
| M-spike g/dL | 0.9 | 0.8 | 0.8 | 0.9 | Best tumor measure | |||||
| IgG mg/dL | 1010 | 1010 | 979 | 1070 | Variation is normal | |||||
| L FLC mg/dL | 2.63 | 1.95 | 2.07 | 2.54 | L Free light chains | |||||
| Calcium mg/dL | 9.6 | 9.7 | 10.0 | 9.9 | Below 10.2 is best | |||||
| Creat mg/dL | 1.0 | 1.1 | 1.0 | 1.1 | Kidney, lower is better | |||||
| HGB g/dL | 14.0 | 14.8 | 14.5 | 14.7 | Hemoglobin, normal | |||||
| RBC M/uL | 3.93 | 4.13 | 4.01 | 4.08 | Red cell count, low | |||||
| WBC K/uL | 5.6 | 3.9 | 3.7 | 4.1 | White cells, normal |
Discussion with Dr. KDS:
Don:
- Peripheral neuropathy from the pomalidomide might be a little worse. It measures the same, but may have increased in areas that I don't measure, such as the backs of my hands. It does not interfere in my lifestyle in any way. There is no sensation from it unless I'm stepping on my feet.
- There are no red bruise marks on my arms this time. Did the reduction to 4 mg DEX make my skin less sensitive to bruising?
- I'm probably not getting slower (running) any more - maybe a little faster, though that may be psychological.
- Wants me to stay on the current 4 mg dosage of DEX for at least 2 cycles before discontinuing it. So at least one more.
- DEX can cause steroid-induced myopathy, but my modest reduction in muscle capacity does not qualify.
- Muscle wasting is probably reversible if DEX can ever be discontinued.
- There is some risk of avascular necrosis of the hip with long-term DEX usage, but she can't quantify it. Balance that unknown risk against the other unknown risk of dying sooner from myeloma. Yikes.
- Get the 2009 H1N1 vaccine when it is available to people in my risk stratum. Immuno-compromised old people are at the top of the "second tier."
- According to the CDC (I looked this up): First tier is pregnant women, then health care workers, then all people age 6 months to 24 years, then people age 25-64 who have health conditions which put them at extra risk. Those first-tier groups comprise about half the population!
- Those of us who are over 64 probably have some immunity already, so we go later, even if we are immuno-compromised.
- Get the seasonal flu vaccine no later than November, but maybe sooner if the "regular" flu season (ignoring 2009 H1N1) seems to be peaking early.
- The two vaccines can be taken on the same day.
- Here is a link to the CDC 2009 H1N1 Flu Page.
- Here is a link to the CDC Weekly Update on Seasonal Flu.
