Three months ago I learned that my M-spike was gone. Since I had yet to undergo a bone marrow biopsy (BMB) to confirm that I had achieved a complete response (CR), my myeloma specialist at Moffitt Cancer Center, Dr. Melissa Alsina, proudly used the word “remission” to describe the achievement.
Yet the next few months were not without complications. My bone marrow had become inelastic and unresponsive. My absolute neutrophil count (ANC) was not recovering after a week or ten days between Revlimid maintenance cycles. Blood tests showed I was neutropenic (an ANC count below 1.0) much of the time. That’s not a good thing, since a chronically low ANC count leaves one at risk for infection.
Dr. Alsina did order a BMB for me last week, in part to confirm that I was in CR, but primarily to get a look at my bone marrow profile to see if I might have developed myelodysplastic syndrome (MDS).
MDS is a blood/bone marrow disorder; sort of a precursor to acute myeloid Leukemia (AML). Tired of all the acronyms? I know I am!
That biopsy showed that I had not developed MDS. Ironically, my marrow was also myeloma free–a result that would have confirmed I had achieved CR if my M-spike hadn’t registered a 0.2 on last week’s test for monoclonal protein. (See yesterday’s post)
Dr. Alsina had placed an order for a cytogenetic test on any my myeloma cells to see if they had developed any chromosomal abnormalities that might make treatment more difficult moving forward. But the pathologist could not identify a single myeloma cell.
As a matter of fact, the pathologist could barely identify any active cells in my marrow. Apparently the cellularity–a measure of active and productive cells in my marrow–was a very low 15%. That’s not a good thing, since red and white blood cells, platelets and a number of other important life sustaining stuff I don’t fully understand is created there. (Isn’t “stuff” a medical term?)
Specifically, the pathology report lists only 0.5% plasma cells present in the sample. That number should be up around 5.0.
Since myeloma is a cancer of the plasma cells, one could argue that’s a good thing. But these cells are designed to become white blood cells. So not enough plasma cells can be as serious as having too many.
Dr. Alsina told me that at least 50% of the cells in my marrow should be active, so 15% isn’t good.
My bone marrow is a wasteland! I couldn’t shake the image of knocking on by my bones and hearing a hollow echo. Or gazing across a vast desert, with only a few cactus and some scrub brush growing along the horizon…
“Based on these results, we obviously can’t increase the dose of your Revlimid.” She said, shaking her head slowly. “Let’s start you on dex again–and increase your Velcade cycle from four weeks on/four weeks off back to four weeks on and two weeks off.”
“Do you give yourself nuepogen shots at home?” She asked? “No.” I answered. “There’s a standing order at the clinic to give me a shot the day after my Velcade infusion if my ANC count is below 1.5.”
Dr. Alsina seemed surprised that my marrow was able to keep my ANC count that high without regular neupogen shots. I began to realize that this was pretty serious.
I’m getting so many kind–but worried–emails about all of this. I’m doing OK. Really! I will pull all of this together and put things in perspective tomorrow.
Feel good and keep smiling! Pat