report on BMB

Finally today we received the full report on the BMB Bone Marrow Biopsy done on June 12. Last week the nurse from the clinic called to say the result was good. But today we sat with Dr T and he went through in greater detail, what it meant.

MM is VGPR very good partial response – the percentage of plasma cells in the marrow is within normal limits, the morphology shows plasma cells to be minimally dysplastic and this suggests that MM is not in complete remission. There is residual trisomy 11(4%).  From 2 years ago, plasma cells was at 4-6% and mildly dysplastic – blebs and nuclear granulation; now it is at 0-1% and minimally dysplastic. There is significant interval improvement and clinically this can be viewed as a MGUS-like state with a small M-spike of 2.33g/L.

MDS is likely to be in remission. FISH  karyotyping shows no abnormal patterns. The high risk clone del7q (18%) appeared in April 2009 BMB was the reason for start of Vidaza, after commencement of treatment, it was not present in the June 2010 BMB (except positive for trisomy 5 and 11) and June 2012 BMB (totally none, no deletion and trisomy). It appears that the treatment with Vidaza over 3 years, has been effective. Dr. T believes that it is because of the concurrent use of Revlimid. He has elected to treat my MDS gradually and slowly with 5 cycles over the first year and 2 cycles in subsequent years as a maintenance therapy.

We could sense his cautious optimism but quiet confidence that this treatment protocol Rdz and Vidaza is working for me. Maintenance treatment is necessary to keep both mm and mds under control. When I can achieve remission for mm, that will be the time he will suggest storage of stem cells. He is hopeful.

Is Control better than Cure? The perennial question often being asked by doctors and patients. At least for me, too aggressive a treatment can make me very sick – I cannot even tolerate 25mg dose of Revlimid – it landed me in hospital for a week. 15 mg of Revlimid gives me more days of fatigue and muscle cramps in a week. 10mg is just about right. This may mean a slow journey but the days are reasonably good, fatigue is not prolonged and there is recovery. As Dr T said, the Asian patients cannot strictly follow the treatment protocols recommended by the drug companies. The dosage and the frequency may need adjustment. It is important to preserve one’s immune system. Destroy the aberrant cancer cells but not ruin the immune system.
As for long-term use of Revlimid and the risk of secondary cancer, Dr T is recommending I complete another 5 cycles before switching to sub-q Velcade as maintenance therapy.  Revlimid has done good, not just for mm but for mds as well, since it is also a recommended drug. But it may be timely to consider making a switch and have another pathway of inhibitor.

To my non-mm friends, all this information may be alien to you. Just know that the doctor is happy, we are HAPPY, you can be HAPPY for us too!

ahhh… we all know that myeloma is a “sneaky disease”, it can morph and turn “dangerous” but we are not going to let it scare us. We cannot live in fear that it will return in a “vengeance”. It can also lie “dormant” and not give us much trouble. Whatever and however it may turn out in the future, we do not need to worry. Live the PRESENT and celebrate TODAY.

For me, I thank GOD.  For I know He is the one who gives restoration to my body. He is the one who grants me that one more day to live. Our lives are in His hands. He is Creator GOD. He can do far better for me than I can imagine and hope.
Psalm 27:13, 14 – “I am still confident of this. I will see the goodness of the LORD in the land of the living. Wait for the LORD; be strong and take heart and wait for the LORD.”

For me, I shall continue to trust and depend on GOD.
Isaiah 26:3 “You will keep in perfect peace those whose minds are steadfast, because they trust in you. LORD, you establish peace for us; all that we have accomplished you have done for us.”

Bloodtest results:

                  
1010
2011
1912
2011
2502
2012
0705
2012
0207
2012
#13
#14
#15
#16
#17
M-band g/L
4.35
3.59
3.43
3.63
2.33
IgG
(6.5-16)
9.83
9.12
9.37
9.21
8.59
IgA
(0-7-3.8)
1.19
1.12
1.11
1.17
1.05
IgM
(0.5–2.0)
0.45
0.48
0.37
0.61
0.43
B2M
607-2454
1573
1374
1334
1578
1426
Album
(37 – 51)
39
39
41
39
37
WBC
(4 – 11)
3.44
3.71
2.76
3.39
3.82
ANC Neutr
1.85
1.71
1.32
48%
1.35
40%
1.41
37%
RBC
(3.8 – 5.4)
4.04
4.3
4.52
4.59
4.17
HGB
(11.5 -16)
12.7
12.9
13.2
13.7
12.3
PLT
140 – 460
220
217
339
205
160
ALP Heat Stable
48
53
52
65
53
AST/SGOT
(0-40)
30
52
29
ALT/SGPT
(3-40)
54
60
42
Creatinine
(0.4-1.1)
0.8
0.73
0.7
0.8
0.84
Calcium
(8.4-10.4)
9.6
9.32
9.4
10.0
9.04
Vit D3
(18-78)
15.6
18.43
HbA1c
5.4
5.5
5.3
1407
2008
1211
2808
1910
2009
1810
2010
1010
2o11
BMD
hip
T-0.6
T -0.3
Z 0.7
T -0.1
Z 0.8
T -0.3
Z  0.6
T-0.2
Z 0.7
BMD
spine
T-0.3
T -0.1
Z 0.5
T 0.0
Z 0.9
T 0.0
Z 1.0
T 0.4
Z 1.4