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Greetings from Little Rock

Posted Mar 18 2013 12:00am
Boy, is it cold here...and rainy.  I'm currently hunkered down in the 8th floor of the cancer center, which is where the entire Myeloma team moved about six or eight months ago.  They've got a couple of computers here so I thought I would avail myself of the Internet connection and update you folks.

There's not that much to report just yet, other than the blood draw went off without a hitch for once (this means they knew to expect me on the 4th floor at the infusion center rather than at the blood lab on the 1st floor).  I had found the little topical freezing spray that my local oncology nurse had given me and a little spritz of that led to a painless port access.  I came back an hour later for a lab printout and everything that's back fromt he labs looks good -- the cancer markers will take another day or so but I'm anticipating everything will be consistent with complete remission.

The PET machine was out of service so my 9:30AM PET scan has been rescheduled.  They gave me the choice of 5:30PM today or 5AM tomorrow morning.  Astute readers will likely guess that I chose the former option.  Still being on West Coast time, even this morning's 7AM wakeup call seemed brutally early.  4AM is not in the cards.

I briefly visited with the irrepressible BJ, BB's right hand.  The visit was enough to answer a couple of questions I had about a new test, the Minimal Residual Disease test which is being done in conjunction with a group in Salamanca, Spain.

The link below addresses a study wherein this test was used to identify those "high risk" myeloma patients that lost remission versus those who did not.  I've not read this carefully enough to paraphrase it here but perhaps I'll do so at some point soon.

http://bloodjournal.hematologylibrary.org/content/119/3/687.long

The second link talks about which of the two tests is more accurate, and what a typical measurement is.  The lowest measure was .001%, or 1 cancer cell in 100000.  The median was 14 cancer cells in 100000 and the high was 1100 cancer cells in 100000.  Notably, everybody in the study was in complete remission.  So some of us with complete remission could still have 1 cancer cell in 1000 cells.

http://www.haematologica.org/content/90/10/1365.short

In this study, they also establish the threshold of "minimal residual disease" being 10 cancer cells in 100000 (.01% cancer cells).  It seems like a subjective threshold, clearly, but it does serve a comparative purpose for test sensitivity.

I was told by BJ that the MRD test at MIRT is sensitive enough to detect one cancer cell in 6,000,000.  It's a bone marrow test using some type of flow cytometry but I recall BB telling me something about an "8-way color array" (this is almost certainly wrong...consider it a placeholder, perhaps referring to the "multiparameter flow cytometry" that the first link above mentions).  In any event, I shall be paying keen attention to the results of that test.

I'm off to the next appointment.  More when events merit and time permits.


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