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Plasma cells and bone marrow on the day before the next transplant begins...

Posted Nov 04 2009 10:07pm
We went to the clinic yesterday to review all my tests and to discuss timing of beginning transplant #2, which I wanted to begin as soon as possible while at the same time being mindful of my bad cold, which had almost departed my sinuses but which was still alive and kicking in my chest. I don't want my immune system being wiped out just in time to let a little bronchial cold turn into pneumonia and a hospital visit again.

The PET scan revealed continued tumor activity in my spine, which I am told is gonna be around for a while (possibly as long as a couple of years!) but which will continue to reduce as it has. Two areas of tumor activity -- one in my sixth right rib and one in my left shoulder-blade -- are completely gone. The rest are reduced from where they were. But there is still diffuse involvement in many vertebrae, some of which have small fractures that will not get worse but are still there. The source of my back pain revealed! This should continue to improve as the cancer is beaten down, so I'm not worried about it. And I asked Caleb, BB's physician's assistant, directly if there was any chance the fractures could worsen to the point where I might find myself back in the hospital on Dilaudid waiting for back surgery, which is an experience I'm not terribly eager to repeat. He said it was extremely unlikely for that to happen, so I'm okay. In any event, the PET scan is good.

The MRI scan revealed continued marrow activity in my back and elsewhere but in general was unchanged from before. Again, slightly surprising given how much the cancer has been reduced but it's hard as the dickens to get it out of the bones once it is there -- the bone needs to turn over and the very last cancer cells have to die off before that can begin, etc. There are no new fractures and essentially everything else is stable, so while again, I wish it showed all the cancer was gone, that's not going to happen for some time, evidently, and everything is stable, so we're good with the MRI.

The Echocardiogram and EKG were normal -- I have mild regurgitation from my tricuspid valve in my heart which I don't think was there before but it is well within the parameters of normal, so I can live with it even though I wish it wasn't there. Importantly, my tachycardia has gone down. It was evidently a temporary situation caused by the transplant and was reflecting of my body working overtime to rebuild blood counts, etc. So that's good.

My bloodwork was generally very good. I've got some nutty things going on with my iron (because my marrow is no longer as clogged with plasma cells I can store iron again) which is good for red blood counts. I am *almost* no longer anemic, with Hemoglobin approaching 13 and red blood counts over 4 for the first time I can recall since I started looking at these numbers back in November. Importantly, red blood cells should not fall that much due to chemo, since they have no nucleus and chemo destroys cells with nuclei. This means that with luck, I'll have higher red blood counts than last time, which means I'll be a bit less tired. Good news!

My liver numbers were still screwy. I did have a glass or two of wine some nights while I was back in Los Angeles, but I didn't drink to excess and they shouldn't have caused the spikes that are there. These numbers were very moderate, with the same type of drinking pattern, throughout my treatment (for example, pre-transplant when I was feeling good I would have a glass of wine or two with dinner some nights and there was no elevation in liver numbers). However, at the time of the transplant they spiked and they haven't come down. Now they aren't crazy high, but they are perhaps 150% of normal. And they aren't moving. The most likely culprit was believed to be Fluconazole, which is one of a family of anti-fungal drugs they give people during cancer therapy. However I've been off that for a month now and the numbers haven't returned to normal. Evidently Velcade also causes irritation in the liver, so that, too, could have been responsible since I got two pushes of that for the last transplant, and will be getting two more in very short order. Hmm...

Anyway these numbers are not too high and I was told they are nothing to worry about -- although they are adding a hepatitis screen to my labs for the day.

Now, to the best part, and sorry to bury this so deep in the mix here, but the bone marrow is MUCH improved from the start of my therapy. Plasma cells are supposed to make up 3-4% of one's bone marrow, give or take. As you likely recall, Myeloma is plasma cell cancer and these cancerous little bastards replicate like nobody's business until they crowd all the healthy cells out. At diagnosis, my plasma cells were SEVENTY percent of my bone marrow. This means there's no room to make red blood cells (hence the anemia) and no room to make white blood cells (which is how many MM sufferers die because they are unable to get rid of infections).

After the round of VTD-PACE (induction) my plasma cells were reduced to around 50%, which was progress but they were still much too prevalent in my marrow.

Well, per the core bone marrow sample done on Wednesday, my plasma cells are EIGHT percent overall, and only FIVE percent in the core of the marrow where immature cells are developing. This is terrific news.

Based on this, we discussed the likelihood of complete remission and it seems my expectations were in line -- there's a very high likelihood that I'll be in complete remission after this next transplant, which would be a nice birthday present for me.

Today, I go to the lab for blood work and to drop off a lovely care package -- 24 hours' worth of urine collected in a jug. No, I haven't been taking after Howard Hughes and doing this in my spare time -- it was requested by the lab. I'll also have the lab change my dressing on my central line as it's been sitting there for a week now and it's time to refresh it. And that will do it for the day, other than picking up more dex for my next course of it starting tomorrow.

Assuming my CRP isn't haywire, we are all systems go for high-dose chemo to begin tomorrow morning at 9AM on the seventh floor. It will be as before: four days of Melphalan, dex and thalidomide with Velcade on days 1 and 4. I'll have shots of Lovenox (blood thinner) in the belly for four days to make sure the thalidomide doesn't cause clots / deep vein thrombosis, and then we'll watch my white blood cells drop until they crater, after which I'll get those awful Neupogen shots for six or seven days. But, I've been through this before, and it wasn't so bad. I'll have plenty of Immodium on hand, suck on the ice chips during the Melphalan and rinse with that nasty mouthwash to keep the mouth sores away, and rely on their anti-nausea meds to keep me feeling good. Then we'll ride out the bumps for a couple of weeks and PRESTO, no more cancer.

And then I'll worry about consolidation treatment. :)

This was a long post -- I've got one other one to report from yesterday's session but it deserves its own entry. Thanks for your readership and support!
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