A few days ago I continued my narrative about how and why the “half-life-effect” is nothing more than an oncology-related rule of thumb–and how the post SCT re-set effect might work in certain patients.
I opened my last post by sharing a discussion I had with the head of the BMT department at Moffitt Cancer Center, Dr. Melissa Alsina.
As we discussed my maintenance therapy options, I was surprised to hear Dr. Alsina bring-up the re-set affect.“It looks like Revlimid is working again for you.” She said. “I think it would be a mistake not to include it in your maintenance regimen.”
Due to the apparent re-set, Dr. Alsina didn’t seem to feel that the half-life-effect would apply in my case.
Neither did my medical oncologist who I saw two days later, Dr. Vikas Malhotra.
Dr. Malhotra and I had a long conversation about this and a variety of other subjects. I trust his judgement. He is bright, obviously cares a lot about his patients and sees 20 or more myeloma patients each year–very unusual for a general oncologist.
While my friend Danny would argue my RVD (Revlimid, Velcade and dex) consolidation therapy is working faster now that I am on a liberal supplement regimen designed to enhance the way RVD works, Dr. Malhotra and I believe Dr. Alsina would argue it is more likely due to post SCT re-set.
In other words, the chemotherapy is working better because last summer’s transplant is enabling Revlimid to work again.
However, Dr. Malhotra has another theory. He believes the SCT had a sort of delayed affect–and the combination of the RVD (most likely thanks to Velcade/dex) and the continued, delayed response of the high dose melphalan are more likely the cause of the dramatic drop of my M-protein levels.
And more good news: Since I only used Velcade for a few months prior to my SCT, Dr. Malhotra would argue that there shouldn’t be a half-life-effect, because my myeloma hasn’t yet become resistant to Velcade.
My conclusion: How about a combination of all of these explanations?
The SCT softened my myeloma up, the RVD–enhanced by careful supplementation–is working better and possibly Revlimid is working again, too as a result of a post transplant therapy re-set.
Regardless of the reason, I have much to be excited about and thankful for!
But doesn’t it bug you at least a little bit that these doctors don’t know why what we are trying is working?
Dr. Malhotra has a direct answer to that. “Medicine is part science and part craft.” He told me. Trial and error. Hit and miss… You pick the cliche’.
“Much of what we do is by feel.” He told me. “That’s why experience is so important.”
Amen to that! Another great argument for working with physicians who see lots of myeloma patients.
Feel good and keep smiling! I am. I’m not even scheduled for another M-protein test until the end of April- Pat