Bone Marrow Plasma Cells down to 40 Percent from 60 Percent – January 2 2013

Chilly drive to St. Luke’s Hospital MSTI, Twin Falls, Idaho with temperatures hovering at MINUS 12 degrees.  However, the roads were dry, skies blue, with sunshine.

Had blood drawn from my new Bard Power Port for the first time – all went fine except for the adhesive dressing they used to cover the Huber Needle access – which itched me. They took it off and replaced it with my Durapore silk tape.

Saw Dr. Padavanija and she had my bone marrow biopsy results from 20 Dec 2012. My plasma cell concentration had decreased from 60 percent (17 Oct 2012) to 40 percent after 2 cycles (a cycle is one month in duration) of carfilzomib/dex/revlimid 10 mg. She was able to speak with Raphael Foncesa, MD at Mayo Clinic Scottsdale, AZ during my appointment to get recommendations on how to proceed. Dr. Foncesa said he was hoping for a better response and now wanted to add Cytoxan to the carfilzomib/dex/revlimid and repeat bone marrow biopsy after 2 cycles.

So, off to the infusion room I trotted. I received the bone building medication, Aredia first at 30 mg vs the 90 mg that I had been receiving. I’m hoping this will reduce or eliminate the flu-like and tiredness that the higher dosage has caused. I have Terry, a 50 year old man from New Jersey who commented on my last Aredia administration to thank for the decreased dosage and the Lancet article supporting its use. Thanks Terry! PS I was born in New Jersey.
RN Brittany gave me IV Aloxi as a pre-treatment for the Cytoxan. Then, I got my 20 mg of Dex IV. Both Dr. Padavanija and Dr. Foncesa are in agreement that I can take more Dex during the week – I will start at 10 mg about 3 days after the 20 mg dose – this should help my tiredness.

I spent well over an hour on the phone with my specialty pharmacy trying to get a refill on my Fragmin 15, 000 units pre-filled injections…this does NOT make me a happy camper!
I got my first Cytoxan dose at 500 mg. I got it IV today, but will be taking it orally once my insurance approves it and it is delivered.
I arrived at St. Luke’s MSTI at 10:20 AM and didn’t get finished until 5:45 PM – a long day in the Infusion Center.

Went to Taco Bell and checked in to my motel – just 9 degrees outside. Fell asleep and woke with redness over my Bard Power Port site…perhaps I am allergic to the plastic on the Huber Needle. The old port site is red too – from the dressing they initially used yesterday.
My other labs from 2 Jan 2012 drawn prior to the start of Cycle 3 of carfilzomib/dex and the beginning dose of cytoxan.

My white blood cell count is low at 3.0 (norms 4.5-11); hemoglobin low at 10.4 (norms 12-16); platelets slightly low at 138 (norms 140-440); and Absolute Neutrophil Count (ANC) low at 1.73 (1.9-8.8).

My kidney function tests are ALL NORMAL on 2 Jan 2012
Creatinine 0.94 (norms 0.52-1.04); BUN 12 (norms 7-17); BUN/Creatinine Ratio 13 (norms 10-20) and GFR >60 (norms > 60).