Staying the Course

Rebecca received her bi-weekly dose of 0.7 mg/M^2 yesterday along with 20 mg of Dex/day for two days. She also had an infusion of Zometia over a 30 minute period. The PN is still persistent as well as the back pain.


The doctor gave her a prescription for Onsolis, a new application method for fentanyl. It is a soluble film you put in your mouth on your cheek. It dissolves in about 15 minutes. She did her first one yesterday when we were at the cancer center. It is a 200 mcg dose. It didn’t do much for the pain. Made her a little groggy. Sixty of these costs $1224, our co-pay was $45. After she takes three of these she can double the dose if she wants by taking one more after the first one dissolves.

She will have another free light chain protein test in two weeks. This will provide an indication on how well the low dose bi-weekly Velcade chemo treatment is keeping her myeloma cancer cells in check. The normal cycle of Velcade is 1.3 mg/M^2 four times every three weeks. She is taking a little less than 20 percent of this amount. We are hoping this low dose will work because of the peripheral neuropathy. If the PN doesn’t start decreasing she may want to stop the Velcade and try something else.

We will be going to UAB on July 7th to get a second opinion and discuss a stem cell transplant.

Here are some of her lab results from 6/25/10:

WBC = 10.2 (4.8 - 10.8)
RBC = 3.34 (4.2 - 5.4)
HGB = 12.0 (12.0 - 16.0)
PLT = 159 (130 - 400)
Creatinine = 1.1 (0.4 - 1.1)
GFR = 51 (>60)

Lambda Light Chains Still Normal

We received the lab results of the Freelite test and SPEP. The lambda light chain protein only increased from 9.53 to 13.1 mg/L. This is insignificant and still within the normal range. We were concern that this number might increase with the recent reduction in chemo treatment.


11 June 2010

IgG 431 mg/dl (700 - 1600
IgA 57 mg/dl (70 - 400)
IgM 11 mg/dl (40 - 230)
IEP - No monoclonal band identified.
Kappa Free Light Chains 10.8 mg/l (3.3 - 19.4)
Lambda Free Light Chains 13.1 mg/l (5.7 - 26.3)
Kappa/Lambda FLC ratio 0.82 (0.26 - 1.65)

Another Chemo Day on 11 June.

Rebecca had chemo on June 11. The dose and frequency has been reduced due to PN which is still about the same. She had 0.7 mg/M2 of Velcade and 10 mg of Dex. He also added 20 mg of oral Dex for two days.


She has an appointment on July 7th at UAB to look into having a stem cell transplant. Their web site is not very up to date. It only mentions bone marrow transplants. However, they have been doing stem cell transplants since the mid 90’s.

Here are some of her blood labs from 11 June 2010:

WBC = 7.9
RBC = 3.15
HGB = 11.4
PLT = 159
Creatinine = 1.1
GFR = 51
Albumin = 3.1
B2M= 3.65 (0.8 - 2.2) MG/L

This is the first time she has ever had her Beta-2 Microglobulin check. A Freelite test was taken and the results should be in by this Friday.

Changing Chemo Plan

I need to be more attentive to this blog. If I would post every time I went on a mountain bike ride that would keep it up to date.

Rebecca has been having more difficulty with peripheral neuropathy. She had velcade on Apr 23 and then took a chemo holiday until May 28 when she had another dose of velcade, 0.7 mg/m-squared. The plan is to try to take this amount every two weeks. The melphalan and prednisone was discontinued since she wants to harvest her stem cells. It is reported that melphalan makes it more difficult to harvest stem cells.

The chemo holiday precipitated a discussion on what we could do if and when there is no chemo plan that works anymore. This normally happens with most every myeloma patient at some point. What is left is an autologous stem cell transplant and an allogeneic stem cell plant. If she can harvest we will put that in the freezer for now. She has two sisters that have offered to be a donor if they are compatible. That is a 1 in 4 chance for each of them.

Rebecca has been having more back pain lately. She had an MRI last week. There were no new fractures. Our doctor only had the narrative report. He said the old fractures are still there. When I asked him if the bones have fused or could the bone fractures still move relative to each other. He couldn’t say. I would like to see the data on a computer screen and compare the last two MRI’s. With the MRI data we should be able to see where the nerves are coming out of the fractured vertebrae. She fractured L2 thru L4 in Oct of 2008, T12, L1, and L5 fractured sometime in early 2009. If it was not for these fractures I think she could have a pretty normal life.

Based on her latest Freelite test the amount of myeloma cells is very low. She will have another Freelite test on 11 June. This should indicate the effects of this change in chemo plan.

Here are some of her blood labs from 28 May 2010:

WBC = 8.1

RBC = 3.32

HGB = 11.9
PLT = 177
Creatinine = 1.1
GFR = 51
Albumin = 3.7

7 May 2010
IgG 458 mg/dl (700 - 1600
IgA 51 mg/dl (70 - 400)
IgM 10 mg/dl (40 - 230)
IEP - No monoclonal band identified.
Kappa Free Light Chains 9.63 mg/l (3.3 - 19.4)
Lambda Free Light Chains 9.53 mg/l (5.7 - 26.3)

Kappa/Lambda FLC ratio 1.01 (0.26 - 1.65)