July 31, 2013

Mary and I met with my Winship Clinic Oncologist yesterday at Emory University. This appointment was a very important one in my treatment because it provided the opportunity for us to do some thinking and decision-making based on his evaluation of the data from my recent bone marrow biopsy and monthly blood analyses in the one hundred days since my stem cell transplant.

Major points discussed were: kidney and liver function in normal range, protein level in the blood (M spike) is now 1.19 which is down from 6 in January – this is a seventy-eight percent reduction in protein. Protein in the blood is a key tag in assessing cancer in the system. My doctor was looking for a ninety percent reduction from the transplant. The bone marrow data revealed that there was five percent myeloma in the sample as opposed to thirty percent myeloma in February 2013. Overall, my body’s response to the bone marrow transplant was good, but there is still some residual disease. This is common in successful transplants. Further action is often needed to achieve the goal of 100 percent remission.

Three options were presented for further treatment:
1. Initiate a maintenance regimen of Revlimid
2. Begin melphalan chemotherapy and undergo a tandem or second transplant – The data supports a second transplant – there are plenty of my harvested stem cells available in storage at Emory University Hospital. Tandem stem cell transplants are almost always done at the University of Arkansas Myeloma Institute and sometimes at the Winship Cancer Institute at Emory.
3. Initiate a maintenance regimen of Pomalidomide, newer version of Revlimid, which is used for resistant cases of multiple myeloma.

We made the decision to start Pomalidomide therapy as soon as possible. My Winship Clinic oncologist will monitor my regular lab results closely. If he does not get the desired response within a month or two, he will proceed to perform a second stem cell transplant. I am guessing that this would be conducted in October. My doctor says that he will keep me on “a tight leash with this option.” The goal is CR – complete remission.

As is my habit, I offer a final word or two. First, I am indeed blessed that the results of the stem cell transplant conducted in April 2013 were successful and good. Second, I am glad that I have two excellent oncologists working together on the treatment of my multiple myeloma. One is my “home” oncologist in Alpharetta and the other is my Winship Clinic oncologist at Emory University Hospital. Interestingly, both are friends from their training days at Emory. They are gifted in their field and are keen on data. My Winship Clinic oncologist settles for nothing less than success and is driven by it as he maintains his reputation in the field on a national level. When he says CR, he means to have it, if he has the likelihood of achieving it. That appeals to me; that is the way that I measure my own success!

So, maintenance with “Pom” begins soon and close monitoring follows. If the data shows CR, then excellent and “Shout hallelujah! Praise God!” If not, then a stem cell transplant will be scheduled. As the data shows excellent results from a tandem transplant, then so be it. I know that a stem cell transplant is no “walk in the park,” but I can do it. I am thankful.

July 31 is the two year anniversary of my diagnosis of multiple myeloma.

Mike Green
July 31, 2013