March 3, 2008

I am so very impressed by Dr Martha Q. Lacy at the Mayo Clinic. I must have spent three hours with her during the last week, and she never seemed in a hurry, though I know that she sees a lot of patients and must be very busy. In addition, she did quite a bit of work on my case in between my office visits, including paperwork for the PET scan so that my insurance would cover it. I felt very cared for.

She ordered the normal battery of blood tests plus a bone-marrow biopsy (BMB), PET scan, and bone survey. The serum cancer markers were ambiguous, not clearly demonstrating an increase in tumor burden. M-spike was up a lot, but IgG was the same, and the bone marrow plasma cell count from the BMB was only modestly increased if at all. Beta-2 microglobulin was down, as was creatinine. Albumin was up, which is good. I suspect that the M-spike increase may be due to testing differences, but that may be true of the downward-leaning counts as well. Actual values from key tests are displayed graphically in the charts and numerically in the test result table.

The plasma cell count is done somewhat differently than before, so I’m not sure how well they compare.

Unfortunately, the PET scan shows bright areas of active myeloma in both scapulae (shoulder blades), and one vertebra, which puts those bones at risk. I am most concerned about the vertebra, of course, because a break there would definitely stop my running, as well as most other activity for a while.

So we discussed two alternative treatment regimens:

• Revlimid with low-dose dexamethasone, or

• A phase-II trial of CC-4047, a new Revlimid analog, also with dexamethasone.

It appears that Dr Lacy herself is managing the trial. It had recruited 13 patients, of 37, and I became number 14. I started treatment that very night, March 7, 2008. So far the symptoms (from the dex) are modest at worst, but we will watch closely.