Even Better News, Probably

Mayo Clinic Visit Wednesday, April 30, 2009, end of Cycle 15:


CC-4047 is an analog of thalidomide and Revlimid, presumably an advancement on both. One little-advertised feature of Revlimid is that a patient's M-spike may decline in two phases. The first phase may take the spike down to a plateau, and if there is a second phase it may produce another gradual decline to even lower numbers, possibly much lower. Dr L has a theory that the first phase may be the Revlimid actually killing the naughty plasma cells, as we might expect, and the second may happen because the Revlimid has helped the immune system itself to fight the myeloma.

The good news for me, perhaps, is that CC-4047 seems to show the same two-phase response for some patients. The CC-4047 study is less than a year and a half old, so information is still somewhat tentative. My own M-spike initially dropped rather quickly from 2.7 to 1.1 g/dL, then to 0.9 and back up to 1.1. In the past four cycles, though, it has gradually dropped again, from 1.1 down to 0.8 g/dL, the lowest level we have seen in the fifteen 28-day cycles that I have been on the study. I can only hope that this is the beginning of the second gradual downward movement.

IgG stayed the same, at 1060 mg/dL, which suggests that the drop in M-spike might be illusory. M-spike is known to be a relatively inaccurate measurement, and indeed the the printout says "no significant change since the last measurement," even though it dropped from 0.9 to 0.8 g/dL. However, since January the drop is from 1.1 to 0.8, enough to be significant. The trend is certainly down, not up.

The only iffy results are the white blood cell and neutrophil counts, both of which took a bit of a dip this month. CC-4047 can cause those counts to tank, which is not good. But they bounce around a bit and have been low before, so we'll see next month. We live month to month, and I'll take this one!

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.

Here are a few specific test results:

Test Feb 05    Mar 04    Apr 02    Apr 30    Remarks
M-spike g/dL 1.0 0.9 0.9 0.8 Best tumor measure
IgG mg/dL 1160 923 1060 1060 Variation is normal
L FLC mg/dL 2.78 2.64 3.04 2.55 Free light chains
Calcium mg/dL 9.7 9.7 9.5 9.6 Below 10.2 is best
Creat mg/dL 1.0 1.0 1.0 0.9 Kidney, lower is better
HGB g/dL 14.9 13.7 14.7 14.3 Hemoglobin, normal
RBC M/uL 4.28 3.89 4.26 4.01 Red cell count, low
WBC K/uL 5.0 4.5 4.2 3.6 White cells, normal


Here are a few other things that Sunshine and I discussed with Dr L: