Cycle #5 Results - RVDD Continues to Dominate

For those who just started following, I have been on a clinical trial to dominate Multiple Myeloma using a four drug combination known as RVDD (Revlimid, Velcade, Doxil, Dex). From what I read and hear the most common protocol these days for newly diagnosed MM patients is RVD (no Doxil). The MMRF funded trial that I am on throws the more old school Doxil into the mix and the results from the 60+ patient study has concluded that everyone has responded to this chemo cocktail.

After Cycle #5, I still haven't achieved Very Good Partial Response (90% reduction), but my numbers are still looking solid and all of my numbers are trending in the right direction. Here they are in Non-Dorky bullet-ed form:

• M Protein was 0.8, now 0.7 [Normal Range: Zero]
  
• IgG was 1120, it's now 806 [Normal Range: 620-1520]
  
• Kappa free light was 10.6, now 8.2. [Normal Range: 0.33-1.94]
  
• Total Protein was 6.6, now 6.5 [Normal Range: 6.0-8.3]

Here is the data in my preferred dorky excel format for M Protein and IgG respectively:





Given the continued success based on my body's response to the chemo, it has been determined that I will move forward with a 7th round of RVDD after the current cycle I am on. The maximum number of cycles is 8, so there is an end in sight. If I end up with 8 cycles, the only issue we run into is that my transplant may coincide with the birth of Child #3. I guess the good news is the delivery room and the transplant recovery room are all connected!

Another Miracle? WBC at 7.8!

I just sat down for my final chemo cycle #5 infusion at UMHS Cancer Center and the nurse handed me my labs. The labs are taken before every infusion because it is important to ensure that my blood counts (White, Red, Platelets, etc.) are not going to low. The chemo dominates the bad stuff, but it also take a tole on the good stuff unfortunately. Because we are preparing for a stem cell collection in February, we need to ensure that my counts don't go too low which could affect the ability to pull enough stem cells.



Being a numbers guy I also pour over every digit to understand changes and trends and then I come up with my own crazy theories that are not scientific and drive Cassie insane! For the past three months I have seen my white blood count (WBC), red blood count and platelets all hover right below the normal range. Low, but nothing to call home about. Today though, all my numbers are in the normal range, including Hemoglobin, and the WBC is 7.8! (normal range 4.0 to 10.0). I don't even have the sniffles, so it's unlikely the number is up become of an infection/illness. I also got my labs from Tuesday and the WBC was 6.3 and all other counts within normal limits.

I will admit that I don't know how significant this is, and I know there are MM patients and experts that read this blog occasionally, feel free to give your reaction based on your experience. Cassie's response was that maybe the chemo is not working as effectively; which is a really good thought. We'll know in two weeks when we get our results from Cycle #5.

On the transplant front, I agreed to move forward with a Chemo Cycle #6 in hopes to get to VGPR (90% reduction of M-protein/spike). I find it unlikely that I will drop from 0.8 to 0.3.... but maybe I should stop trusting in my own understanding and play dumb. Seems to have good results!

Cycle #4: Test Results are in!

No graphs this time, just more good news. Of the numbers we are tracking and that are closely tied to MM getting dominated, all are trending down...which is the direction we want them to go!

The M-protein is down to 0.8 (3.0 to 1.9 to 1.2 to 1.0, now 0.8). If it falls another half a point I will be in Very Good Partial Response (VGPR), which would be outstanding heading into my first, of possibly two transplants. 

For those MM enthusiasts out there:

• IgG continues to drop, it's now 1120 (was 1350)
  
• Kappa free light was 20.1, now 10.6. The K/L ratio went from 100 to 50.
• Total Protein is 6.6...Perfect! (Was 8.2 at diagnosis which tipped off my hematologist)

People continue to ask how the treatment is going and I can honestly say that going through hell in cycles #1 and #2...read the old posts if you don't remember, has made Cycle #3 and #4 seem like cake. I am now onto #5, which seems to be following suit! 

So what does Phil want to happen next? 

1. I want to see my M-protein to continue to get dominated. What would make me REALLY HAPPY is to see it at 0.3 after chemo cycle #5, but I would probably be pumped to see it at 0.5 as well. Those numbers would encourage me to go after another round of chemo to try to knock this thing out of the park even before my first transplant.
2. I want to see my kappa to continue to drop. These light chains dominate the kidneys and are a key indicator on how the disease is doing. The chemo is working a number of the kappa, so I just ask that it keep receiving the domination!
3. I want to have peace about when to start my first transplant and peace about whether or not to do a second one. There are financial ramifications to two transplants which don't need much discussion on our blog, but just a reality that we can't avoid. One important note is that it seems that both my oncologist and BMT doc may agree to harvest and collect my stem cells after Cycle #5. I still have to do a little more research to understand whether it's better to reduce the M-protein before collection or not. Unfortunately the chemo bombs affect the good bone marrow too, so the docs want to make sure they get enough collection for two transplants. Being young, I don't think that will be a problem and I still need to trend my blood counts (white, red, platelets) to verify that my counts haven't really gone down much during treatment. 
4. I want my Wolverines to compete for a Big Ten Championship again.

Thanks everyone for the prayer, support and such kind words! There's nothing but good news following Cycle #4 and we expect in three weeks when sharing results from Cycle #5 it will be nothing but the same.