Chemotherapy Update – Cycle 6 results
Sibs,
This Monday marked the end of Chemo Cycle 6, and the completion of the Chemotherapy Phase of my treatment for Multiple Myeloma. As usual, Irene and I met with the Myeloma physician and the research assistant to review my progress and also to discuss the hand-off from the Oncology Team (we’ll have a follow-up visit with Dr. J in 10 weeks) to the Bone Marrow Transplant Team.
These last 3 weeks have been very busy – at times chaotic – intensified by a short-notice, disruptive schedule that UofM inflicted upon us mid-Cycle. This took an emotional toll on me (and Irene) as I tried to accomplish all of the pre-admission procedures, prepare myself for Transplant hospitalization, and still work full-time for the Burton Group.
How disruptive was it? In addition to the usual twice-weekly chemo infusions, other procedures included a Bone Marrow Biopsy, spine surgery (“kyphoplasty”), a spine biopsy, a cholesterol screening, an ekg, an echocardiogram, a pulmonary function test, a PET scan, a slew of x-rays, an oral exam (the Transplant Team requires a “no disease of teeth or gums” statement from your regular dentist), and separate clinic consults with Oncology, Orthopedic, and Transplant physicians. MOST of the results from all those procedures were good news; but one result requires follow-up treatment.
THE GOOD NEWS
The best news is the Bone Marrow Biopsy, which measured zero% Myeloma cell concentration in my bone marrow and resulted in the “complete remission” statement by the Cancer research team (at diagnosis in April the concentration was 40%). Other good news is that the spine surgery at L3 went well and the hip/pelvis pain that it was intended to correct is reduced (not completely gone, but better). The biopsy of the lesion in that L3 vertebrae (performed at the time of the surgery) was negative for cancer. The other tests on my heart and lungs showed “normal results” – nothing to prevent me from proceeding with the October Transplant.
THE FOLLOW-UP TREATMENT
The PET scan was normal for everything that the Transplant Team would be worried about, however there was evidence of ..something… near the valve which separates the large and small intestines {i think}. “Minimally decreased FDG uptake in the region of the bilateral femora and tibia, which is most likely physiologic/reactive.” Dr. J explained that he doubts this is anything to worry about, but since colon cancer is the number one preventable killer today AND I am due for a colonoscopy anyway that we might as well go ahead and schedule a colonoscopy prior to Transplant (with special instructions to inspect the valve and the terminus of the small intestine… a little farther {aieee !} than where a standard colonoscopy goes). Hey, I wasn’t doing anything for the next week, anyway!
BONE MARROW TRANSPLANT
Being in “remission” does not equate to being “cured.” This disease is still in my body and the best treatment includes transplant(s) to further combat the disease and extend the remission interval (and thus extend life). My hospitalization date for the autologous (self) Bone Marrow Transplant has slipped from September 24th to “one day during the first week of October.” I’ll probably be in the hospital for 3 weeks and then spend 2 – 3 months recovering at home. We still have not decided upon that second transplant, BUT – in view of my excellent chemotherapy results – Dr. J suggested an alternative in our meeting yesterday: delay the second transplant indefinitely until some future date, probably associated with the inevitable recurrence of Myeloma as it progresses from remission to an active state. {I wonder if the Bone Marrow Transplant physician, Dr. K, will concur with the Oncology physician, Dr. J’s, alternative? Stay tuned, bone marrow candidate donors Micki and Laura…}
More statistics from Dr. J yesterday on the donor transplant success rates: 20% are totally cured of the disease (hooray!!); 15% die within one year (boo!!), 20-30% suffer severe graft vs host disease (ugh!), the remainder have the same success/remission interval as a much-lower-risk self-donated transplant. As I have said before: the decision for self- vs donor- stem cells for that second transplant will not be an easy one.
WHAT HAPPENS BETWEEN NOW AND OCTOBER FIRST?
Compared to the previous three weeks, the next three weeks look absolutely boring! The aforementioned colonoscopy is not scheduled yet, but must be performed prior to September 14th or wait until at least after January. On the 14th I begin the 5 day regimen of self-injected Neupogen (4 injections per day, 1200 mg total daily) to build white blood cell counts. Bulked-up on white cells, I then begin “apheresis” (cell harvesting, filtering good stuff from blood very much like a kidney dialysis machine) which will take from 1 – 4 days depending on the volume of each day’s harvest. That leaves me with about 8 days of “nothing to do” before hospitalization – time in which I _plan_ to finalize a number of Burton Group projects before going on a leave of absence, but _suspect_ that UofM will disrupt with things we don’t even know about yet.
That’s the latest news from Hamburg,
-larry