September 16, 2008:

Seven four-week cycles of the phase-II trial of the new Celgene drug CC-4047 are now complete, and overall results are great. M-spike is unchanged this month at 1.0, but down from a high of 2.7 at the start of the trial. IgG is up a little but I have a cold which can make it go up, and Lambda free-light chains (FLC) are at the lowest level in five years of measuring them. Doctor L used the word "stable" to describe my myeloma. Stable is good.

White cell and red cell counts are mostly unchanged, also good. Blood pressure, which was about 150/80 last month, was down this month, probably because Dr. L reduced my dosage of dexamethasone (dex) from 20 mg once weekly to 12 mg. That 12-mg dosage continues for the ongoing eighth cycle. This is the entire protocol as prescribed by Dr. L:

• 2 mg CC-4047 every day, no days off. I take it at bedtime.
• 12 mg dexamethasone once weekly. I take it with Sunday dinner, so Monday is "dex day" for me.
• 325 mg generic aspirin daily, to prevent deep-vein thrombosis (DVT). I take half in the morning and half with the CC-4047.
• 75 mg generic ranitidine (Zantac) twice on Sunday and once Monday morning, to mitigate stomach problems from the dex.
• 400 mg generic acyclovir daily, to stave off shingles.

Here are some related links:

	My Myeloma		A discussion of my myeloma, not very technical.
	My Treatment History		Not technical.
	My Test Charts		Graphic displays of several key test results over time.
	My Test Result Table		Best with a wide browser window. Very "technical."

Side effects of the two key drugs, CC-4047 and dexamethasone, are discussed in a previous post.

Other subjects that came up:

• The side effects of dex are mostly reversible, except for cataracts. So far I haven't had that problem.
• Would lutein be of value in fending off cataracts? Curious minds want to know. Eat your Brussels sprouts.
• Every myeloma treatment works better with dex than without. Darn.
• The half-life of the IgG protein, whether monoclonal or normal, is four to six weeks (!).
• IgG is a measurement of all immunoglobulin G proteins, while M-spike measures only the monoclonal part of IgG.
• The half-life of light chains is two or three hours.
• Hence the light chains can be a more-current snapshot of what's going on, compared with IgG or M-spike.
• Events in the body can make light chains go up and down, but kappa and lambda normally go up and down together.
• The exception is myeloma, which makes one go up independently. This is why the ratio of kappa to lambda is useful.
• Celgene seems to be calling CC-4047 "pomalidomide" now. But it still says CC-4047 on the bottle of capsules that I get.
• Revlimid can cause thyroiditis, causing the thyroid to first become overactive and later become underactive (hypothyroid).
• Since CC-4047 could have a similar side effect, Dr. L checks my thyroid every three cycles. So far so good.
• CC-4047 appears to have much less effect on white and red cell counts than Revlimid, which can depress counts substantially.

Here are a few specific test results:

Test		Jun 26		Jul 24		Aug 22		Sep 16		Remarks
M-spike g/dL		1.1		1.1		1.0		1.0		Best tumor measure
IgG mg/dL		1450		1330		1040		1180		Variation is normal
L FLC mg/dL		4.03		3.30		3.57		2.64		Free light chains
Calcium mg/dL		10.1		9.7		9.3		9.7		Below 10.2 is best
Creat mg/dL		1.0		1.0		1.3		1.0		Kidney, lower is better
HGB g/dL		14.8		14.3		13.8		13.6		Hemoglobin, a bit low
RBC M/uL		4.28		4.17		3.99		3.90		Red cell count, low
WBC K/uL		5.5		4.7		4.4		5.3		White cells, normal

Red cell count and hemoglobin are on the low edge. I will continue to try to treat those with sublingual B-12 for another month.

Meanwhile I'm still running and life is good.