October 16, 2008:

Eight 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 dropped again this month from 1.0 to 0.9, down from a high of 2.7 at the start of the trial. YAY! IgG is virtually unchanged, and Lambda free-light chains (FLC) are up a little but so are Kappa chains, and the ratio is actually a bit higher (better).

White cell and red cell counts are mostly unchanged, also good. Blood pressure, which was about 150/80 two months ago, was down to about 122/58 this month, probably because Dr. L has reduced my dosage of dexamethasone (dex) from 20 mg once weekly to 12 mg. That 12-mg dosage continues for the ongoing ninth cycle. The entire protocol as prescribed by Dr. L is detailed in a previous post.

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.

Dexamethasone affects (increases) the level of glucose in blood, which is not good. Therefore, although I am not a diabetic, I occasionally use a blood glucose meter. I have previously measured blood glucose at roughly half-hour intervals on "dex day" when I was taking 40 mg of dex, and later 20 mg of dex, and also no dex (an ordinary day). Last Monday was dex day once again, like all Mondays, and I made those measurements after taking 12 mg of dex the night before. Here is a chart that shows the results for 40 mg, 20 mg, 12 mg, and no dex. Bottom line: 12 mg of dex last Monday resulted in blood glucose levels at least as high as they were on 20 mg of dex last May 19. That was a surprise to me, but not to Dr L, see below.

Other subjects that came up:

• It appears that a person's sensitivity to dexamethasone increases with use. Therefore, after a time, a lower dosage of dex will produce much the same effect as a higher dosage did previously. We were discussing side effects when Dr L mentioned this, so I do not know if that also applies to the anti-myeloma benefit of dex.
• I asked whether or not it was time to harvest stem cells against the eventuality of a stem cell transplant. Dr L responded that the CC-4047 trial protocol does not make provision for this, so I guess I will wait until the trial is over for me. I'm OK with that - there is NO chance I will want a transplant unless the trial fails for me.
• 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.