Tuesday, March 22, 2016

Multiple myeloma: New drugs offer hope to patients

March is Multiple Myeloma Month! It is the month chosen to celebrate the courage of multiple myeloma patients and their caregivers and to increase awareness about the disease, thereby increasing the prospect of funding for more research. Indeed, it has been a success story to build on.

In the past few months, five different drugs or drug regimens have been approved by the FDA to treat the disease. This certainly increases the prospect of increasing the survival of patients with this disease, until now considered incurable. Following the lead of Bart Barlogie, M.D., Ph.D., a prominent researcher and multiple myeloma expert, it is time to start thinking about and working toward the cure.

First, what is multiple myeloma? It is a blood disorder that involves abnormal proliferation of plasma cells, the cells responsible to make antibodies to protect us against infections. For people who suffer from this cancer, their immune system is very low; that puts them at risk for infection. This disease also causes anemia, renal failure, bone disease leading to fractures and high calcium in the blood, causing symptoms such as drowsiness and muscle and heart problems.

The American Cancer Society estimates that 30,330 people will be diagnosed with multiple myeloma and 12,650 will die of the disease in 2016. The number of people diagnosed with multiple myeloma has been increasing over the past decade. Fortunately, the death rate has not shown the same trend, due to introduction of more effective drugs and treatment regimens. Patients with multiple myeloma are living longer and longer.

For one of my patients, the approval of daratumumab (Darzalex), a human antibody aimed at a surface marker on the myeloma plasma cells named CD38, could not have come at a better time. He had exhausted most standard treatments, including experimental regimens on clinical trial. His bone marrow could not withstand any further assault from chemotherapy. After much discussion, we agree to start daratumumab. He has had an excellent response, one of the 30 percent of patients who usually respond to this drug, including bone marrow recovery that may allow him to explore other options later on, a true success story.

Another patient of mine in a similar predicament was started on another recently approved new regimen of elotuzumab (Empliciti), another antibody aimed at another surface marker on myeloma plasma cells named SLAMF7 in combination with lenalidomide, another very effective drug in multiple myeloma, and dexamethasone, a steroid. He is also experiencing a very good response.

These drugs are clearly very effective and have the potential of changing the way we treat multiple myeloma. Other drugs and drug regimens recently approved include ixazomib (Ninlaro), an oral proteasome inhibitor approved in combination with lenalidomide and dexamethasone; carfilzomib (Kyprolis), with lenalidomide and dexamethasone; and panobinostat (Farydak), a new drug approved in combination with bortezomib and dexamethasone.

The basic theme of multiple myeloma treatment is that a combination of drugs is better than single agents, and that the combination of drugs with different mechanisms of action is effective even in cases where the single agents by themselves may not be completely active and thus can overcome resistance. As always, when living in abundance, we need to learn not to waste. In the case of multiple myeloma, we need to use our bounty when it benefits patients best. That is a learning process, since we do not have yet clinical trial data to guide us currently. Until then, it is best to seek the experience of a multiple myeloma doctor.

Raymond Thertulien, M.D., Ph.D., is a former member of the Myeloma Institute of Research and Therapy in Little Rock, Arkansas, and has performed extensive research and published several papers in multiple myeloma. He is a member of Asheville Hematology and Oncology and a board member of the Western Carolina Medical Society Association.


Monday, March 21, 2016

Medical Illustration: Multiple Myeloma

Medical Illustration: Multiple Myeloma
Multiple myeloma begins with a single precancerous plasma cell that multiplies uncontrollably and can eventually cause bone lesions and anemia.

1. Normal bone marrow produces new blood cells, which include red blood cells, white blood cells (neutrophils, plasma cells and monocytes) and platelets.

2. Monoclonal gammopathy of undetermined significance: Elevated levels of M protein due to an increased number of plasma cells. Bone lesions are absent. No treatment is necessary. Disease should be monitored every six to 12 months.

3. Smoldering myeloma: Elevated levels of M protein due to an increased number of plasma cells. Bone lesions are absent. Standard of care is to monitor disease without treatment. Enrollment in a clinical trial comparing treatment to observation might be an option.

4. Solitary or intramedullary plasmacytoma: Elevated levels of M protein, increased number of plasma cells and a single tumor in the bone or soft tissue. Treatment typically consists of radiation therapy.

5. Multiple myeloma: High levels of M protein and elevated levels of plasma cells accompanied by multiple painful bone lesions and anemia. Kidney damage might also be present. Treatment options include chemotherapy, targeted agents and immune modulators with or without bone marrow transplantation.


Thursday, March 17, 2016

Happy St. Patrick's Day

80 Months of Complete Remission

Got the call a little while ago.

Dom remains in complete remission, but his numbers are a LITTLE concerning to me.   (His doctor isn't fazed a bit).  Light Chains are high.  Their ratio is normal.

M-Spike is now 0.6, while it had been 0.3

Normal levels of serum free light chains are:
• Kappa: 3.3–19.4 mg/L
• Lambda: 5.71–26.3 mg/L
• Kappa/lambda ratio: 0.26–1.65

His March numbers are:
*Kappa:  25.67
*Lambda:  28.00
*Ratio:  0.91

I know that many MM patients would be tickled with these numbers.  Perhaps I expect too much.  (They're sending me a hard copy of all of his numbers)

We'll see what happens in June.

Happy St. Patrick's Day!

Monday, March 14, 2016

A St. Patrick's Day Prayer

Blessed St. Patrick's Day!
From 'St. Patrick's Breastplate Prayer':

I bind unto myself the Name,
The strong Name of the Trinity;
By invocation of the same.
The Three in One, and One in Three,
Of Whom all nature hath creation,
Eternal Father, Spirit, Word:
Praise to the Lord of my salvation,
Salvation is of Christ the Lord. Amen.

Saturday, March 12, 2016

Fighting Multiple Myeloma Could Be the Key to Good Health Later in Life

Milwaukee -
Multiple myeloma is a type of blood cancer, but most often it is undetected by patients.

It's a cancer that starts in your blood's infection-fighting plasma cells, which are normally found in bone marrow.

When plasma cells become cancerous, they can rapidly multiply, forming tumors in bones and causing bones to weaken.

Multiple myeloma is the second most common blood cancer, after leukemia and lymphoma.

It affects about in out of every 143 people in the U.S. in their lifetime, according to the American Cancer Society.

This year ACS anticipates about 30,000 new cases in the U.S., with men having a slightly higher number of cases than women (nearly 60% of cases are expected to be men)

In early stages, the disease doesn't present any symptoms, making it challenging to diagnose.

Symptoms may include bone pain and constipation, a loss of appetite, weakness and feeling faint.

Normally these symptoms will build over time and if you have any you should see your doctor as soon as possible to have blood drawn.

The risk factors for multiple myeloma are not conclusive, because the cause of multiple myeloma is not known.

Researchers believe that multiple myeloma is most likely the result of many risk factors acting together.

There are, however, some factors that may be associated with an increased risk include genetic factors, prevalence of MGUS, occupational exposure, age, race, and gender.

The most significant risk factor for multiple myeloma is age, as 96% of cases are diagnosed in people older than 45 years, and more than 63% are diagnosed in people older than 65 years. Thus, it is thought that susceptibility to multiple myeloma may increase with the aging process.

Unfortunately there is no complete cure for the disease, but with treatment, people can return to a near normal life.

Treatment options can include chemotherapy or radiation, depending on the individual case.

In some instances, bone marrow or stem cell transplants might be an option. And in some other instances, surveillance may be recommended to just monitor the condition if the cancer is a very developing cancer.

Each individual case is unique and it's important for people to find a cancer care team that can meet their specific need.

There is a toll free number for more information: 888-649-6892.

Dr. Fred Sanchez of Aurora Health Care was a special live guest on the CBS 58 News at 4 to talk about it. His interview is attached to this story.


Friday, March 11, 2016

Agent Orange exposure linked to bladder cancer, hypothyroidism

A new review of Agent Orange research found evidence that bladder cancer and hypothyroidism are more strongly linked to exposure to the herbicide than previously thought, but the science does not support a previously held belief that spina bifida occurs in the offspring of exposed veterans at higher rates.

A report released Thursday by the Institute of Medicine on the health effects of Agent Orange also recommended the Veterans Affairs Department grant service-connected presumption to veterans with “Parkinson’s-like symptoms,” not just those diagnosed with Parkinson’s disease related to Agent Orange exposure.

The 1,115-page review is the final in a series conducted by the IOM on health problems related to Agent Orange and other herbicide use during the Vietnam War.

“There is no rational basis for exclusion of individuals with Parkinson’s-like symptoms from the service-related category denoted as Parkinson’s disease," members of the IOM panel wrote in the report.The panel, chaired by Kenneth Ramos, professor of medicine at the Arizona Health Sciences Center, University of Arizona, reviewed the scientific literature on Agent Orange released between October 2012 and September 2014 for its review.

The decision on bladder cancer and hypothyroidism was tied to results of a large study of Korean War veterans who served in the Vietnam War suggested an association while the choice to downgrade spina bifida was based on a lack of data, panel members said.

“[The inclusion of] spina bifida in the limited or suggestive category of association was based on preliminary findings from [an ongoing Air Force study]. However, to date, a complete analysis of the data from that study for neural tube defects has not been published … [and] no subsequent studies have found increases in spina bifida with exposure to components of the herbicides sprayed in Vietnam," they wrote.

JUMP for more....

Our Flooding

 This was our tiny little branch.... now a river
 Our pond is overflowing.

Thus far, we've gotten 9 inches of rain here since midnight.

A lot more coverage here:




Thankfully, we don't need to leave the house until Wed. for Mass!

Tuesday, March 1, 2016

VA benefits available for those impacted by Agent Orange

When Bob Blower was diagnosed with prostate cancer in 2001, he underwent successful surgery and moved on.

A year later, when his friend Vince Kilmartin was diagnosed with prostate cancer, Blower helped guide him through the treatment. Kilmartin also underwent successful surgery to treat the disease.

Six years later, in 2008, Kilmartin happened to see in a newspaper article that a Veterans Administration study found a link between exposure to Agent Orange, the anti-defoliant used in Vietnam, and prostate cancer.

When he spoke to someone in the Oakland VA office, Kilmartin learned that not only was he eligible for benefits related to his treatment for prostate cancer, but also for the two heart procedures he'd had to put stents in because of blocked arteries.

Prostate cancer and blocked arteries are just two medical conditions the Veterans Administration links to exposure to Agent Orange. Although the VA doesn’t contact veterans about potential benefits they may be due, it does have a wealth of information on its website ( va.gov, under benefits, special groups, Vietnam veterans). Veterans have to take the initiative, though.

Kilmartin received his benefits in 2008, but the veteran with 20 years of active duty — five in the U.S. Navy and 15 more in the U.S. Coast guard after a career in education — didn't give it much thought afterward.

But last fall when he and Blower were playing a round of golf, their having had prostate cancer came up in conversation.

“I said, ‘Bob, did you ever apply for VA benefits?’” Kilmartin remembered. “He said, ‘No, how would I know that?’”

Blower spent five years in the Navy, including a year aboard the USS Magoffin, a TAC Transport, which was docked in Danang in 1966. He left the military after five years in the naval reserves, and moved onto his civilian life, becoming a Realtor and raising a family.

When he was diagnosed with cancer, his past military service never entered his mind, but Kilmartin knew better.

“He mentored me,” Blower said. “He told me you have to get all your medical records, your military records and where your ship was.”

The two met with Jerry Jolly at the San Joaquin County Veterans Services office and provided Blower’s discharge papers, the name of his ship and the medical records that proved he'd had prostate cancer. Blower is now awaiting his benefits.

“We started thinking there are probably a lot of guys like me who didn’t know they were eligible,” Blower said.

Exposure to Agent Orange has been linked to a 52 percent overall increased risk of prostate cancer in Vietnam vets, according to an analysis published in the American Cancer Society journal Cancer. Spreading the word about the connection, and the benefits available, has become the mission of Kilmartin and Blower.

It’s been one of Tino Adame’s jobs for a long time as the American Legion’s state chairman of veteran affairs and rehabilitation.

“My job is to get the word out to veterans through the American Legion or any other veterans organization, any way I can,” Adame said. “I need to get veterans informed about Agent Orange, what’s covered. “

It’s important work for Adame, a U.S. Marine who served in Vietnam in 1966. He’s devoted to veterans and was long involved with Stockton’s Karl Ross American Legion post before working at the state level.

Adame was diagnosed with prostate cancer in 2010 and received VA benefits.

He is now undergoing chemotherapy for tumors on his kidneys, but that cancer is not linked to Agent Orange at this time.

The U.S. military sprayed nearly 20 million gallons of herbicides on South Vietnam and parts of Laos and Cambodia from 1962 to 1971 to defoliate the jungle cover of enemy soldiers and to destroy their food source. Veterans exposed to the chemicals, in particular dioxin, began experiencing illnesses as early as the 1970s. The U.S. government initially resisted an admission that Agent Orange had caused health problems, but has since expanded its list of illnesses “associated” with exposure. That list now includes numerous cancers (prostate, non-Hodgkin’s lymphoma, Hodgkin’s Disease among them), Parkinson’s disease and certain heart conditions. More studies are ongoing, Adame said.

“It stirs a lot of memories,” Adame said. “Talking to other vets, we could all see it (when it was sprayed). I was a squad leader and I’d radio the helicopter and tell them we were under them and they’d say, ‘sorry, we’re ordered to spray here. Get under a poncho.’”

Kilmartin, too, remembers the spraying.

“When we flew into Danang, you got off the plane and you could see the stuff,” Kilmartin said. “They’d be spraying in areas where the fighting was going on, where the Marines were out in the field. They’d start flying and the Agent Orange would be sprayed everywhere, and the wind would blow it back.”

Most veterans who served time in country during the Vietnam War were exposed to the toxic chemical.

If little consideration was given to troops at the time of the spraying, the U.S. government is now making amends. Veterans, though, need to ask for help.