I met with my myeloma specialist, Dr. Melissa Alsina, at Moffitt Cancer Center in Tampa yesterday.
Great news! After completing my third, six week full dose RVD chemotherapy cycle, I learned that my monclonal protein reading (M-spike) has continued to edge downward.
Let me back-up and fill-in a few of the blanks for our new readers.
RVD (Revlimid,Velcade and dexamethasone) is considered by most myeloma docs to be the gold standard of myeloma therapy.
It can be used for induction (the initial treatment for newly diagnosed patients and/or before harvesting stem cells and/or proceeding to transplant–or for consolidation (post SCT) like we are doing for me now.
If you recall, my doctors were shocked when my M-spike was significantly higher after my transplant this summer than it was before.
I started with a clean bone marrow biopsy and a low, 0.2 M-spike. But three months following my SCT, my M-spike was up to 0.6.
This was serious, since my form of myeloma starts to attack my bones in the 0.5 range.
Since RVD had worked for me during consolidation, Dr. Alsina and my medical oncologist, Dr. Malhotra, settled on a series of six week RVD cycles to try and get things back under control.
Velcade once a week sub-q for four weeks, followed by two weeks off. Revlimid 25 mg for 21 days, with 7 days off. And 40 mg dexamethasone once each week.
This combo is hard on me, but it is working very well. As a matter of fact, it is working better now than it did before my transplant.
Dr. Alsina feels my transplant hit the “reset button,” allowing Revlimid to be more effective than it was after almost five years of continual therapy before my transplant.
And she may have a point. My M-spike has been dropping faster now than it did before. It has gone from 0.6 to 0.3 after the first six week cycle, then down to 0.2 and now 0.1.
That’s the good news. The not so good news–at least for the near-term–is that Dr. Alsina recommended an additional two or more RVD cycles.
That means more fatigue, low white counts (neutropenia) and revved-up peripheral neuropathy.
But that OK. Since 25 mg of Revlimid is especially hard on me, Dr. Alsina did give me the option of cutting the dose down to 15 mg.
My response: Heck no!
Inconvenient side-effects or not, we both agreed to hit this thing hard now–while we have it on the run.
We discussed possible maintenance strategies, too. But since I won’t see Dr. Alsina until after two more cycles (three months) are complete, we agreed to table our discussion until the end of April.
At that point, my guess is she may recommend an additional cycle or two before we move into maintenance mode.
The bottom line: It looks like I’m going to be around for awhile, gang!
I was starting to think about my survival in terms of months. I much prefer thinking in years! Between the remaining RVD cycles, maintenance and then an inevitable, hopefully slow return of my myeloma, we are probably talking about two or maybe three years before moving into some sort of salvage therapy.
Plenty of time for Onyx and Celgene to finish-up their carfilzomib and pomalidomide studies…
Yep. I’m going to have enough time to finish books number four, five and six.
And based on the success of Danny’s Diet and Multiple Myeloma series, our helpful tech volunteer, Robb, Pattie and I are already planning on upgrading our long running Help With Cancer.org site to feature more helpful info about nutrition and anti-cancer supplements.
Lots to do–and more time to do it. Life is good!
Feel good and keep smiling! Pat