ANOTHER UPDATE on Dom

Dom is having a pretty rough way to go during this treatment.  Actually, Thalidomide was like a walk in the park compared to Velcade, Revlimid and Dex.

His blood pressure is all over the place.  He’s been on blood pressure medication for many years.  Our family doctor took him off of it while he’s going through this.

A typical morning:

Gets out of bed at 8 am.  While watching television, sitting on the couch, his blood pressure is 130/80.  GREAT.

Gets hungry.  Walks with his cane 20 feet into the kitchen.  Grabs a bite to eat, then hobbles back to the couch.  Starts feeling woozy.  Blood pressure has dropped to 60/something.

An hour later, blood pressure returns to normal.

He cannot function with these fluctuations.  He’s also getting flashes of color in his peripheral vision from time to time.

I’m doing all of the driving.  We’re both very tired.  Drive into Bogalusa, LA every Monday for lab work.  Velcade injections in Slidell on Tuesdays and Fridays.  Drive into NOLA to see Dr. Safah at the Tulane Cancer Center every couple of months. Monthly infusion of Zometa.  Here’s a look at this month:

So, we're hanging in there and sure looking forward to finishing this treatment and get on with the transplant.

Dom's Cancer is Back

Well, gang-  after complete remission for over 7 years, his MM has returned.

His blood work and bone marrow biopsy showed absolutely nothing alarming.  His hip had really been bothering him, so Dr. Safah ordered an MRI.

We went to see her on Thursday, fully expecting yet another clean bill of health.

NOPE.

The MRI showed a 9.3-centimeter lesion on his left hip.  (Measures 3.66 inches in diameter).

So, she calmly announced that he was to stay off of his tractor, watch how he sits down, etc.  She's afraid that he would suffer a broken hip.

Then went on to say that she was ordering 10 radiation treatments, 2 months of Chemo and ANOTHER Stem Cell Transplant.

Needless to say, my eyes filled with tears.  She smiled and sweetly said that she wasn't the least bit concerned.  He did so well last time and remained clean for so many years..... that he would breeze right through this.  She said that this time it would be much easier on his body.

We met with a Slidell Radiologist doctor and our Slidell Oncologist on Monday and Tuesday.  The Radiology department did a CT Scan and tattooed his hip.

Our Slidell Oncologist said that he suspects that this is a Plasmacytoma, as his bone marrow and blood wasn't the least bit alarming to them.

Radiation begins tomorrow.

This time around his Chemo will consist of Revlimid, Velcade, and Dexamethasone.

My tears have ceased and we're both very confident with our new team.  Dr. S. from Tulane told both of these Slidell doctors that he would zip right through this process.

After Radiation and Chemo, they'll gather his Stem Cells and the transplant will be done in New Orleans at Tulane.

This is all happening very quickly.  We walked around in a daze all weekend but hit the ground running on Monday.

Combo Shows Response Benefits for Smoldering Multiple Myeloma

A three-drug combination showed both tolerability and favorable overall response rates (ORR) for patients with smoldering multiple myeloma in a phase 2 trial.

The triplet of Empliciti (elotuzumab), Revlimid (lenalidomide) and dexamethasone showed an overall response rate (ORR) of more than 80 percent, while also proving to be well-tolerated in a phase 2 trial of patients with high-risk smoldering multiple myeloma (SMM), said Irene Ghobrial, M.D., who presented the data at the 2016 American Society of Hematology (ASH) Annual Meeting.

Patients with SMM are a heterogeneous group who have a risk of progression to MM of about 10 percent per year, “yet we know that some of those patients who are high-risk smoldering myeloma patients are the ones who have a high chance of progression of 50 percent over two years,” said Ghobrial, attending physician, Medical Oncology, Dana-Farber Cancer Institute. In this latter group, the possibility to prevent progression through early therapeutic intervention is intriguing.

The appeal to early therapy is inhibition of clonal evolution, possibly enabling cure. “These patients also have a very good immune system, and therefore immunotherapy…could be very appealing because it could potentially cure those patient in the early stages,” she said.

A significant improvement in progression-free survival (PFS) was realized with the combination of Revlimid and dexamethasone in high-risk SMM compared with observation, and the response rate in the first induction phase (before maintenance) was 79 percent.

She and colleagues therefore sought to determine whether early therapeutic intervention with Empliciti, Revlimid and dexamethasone in patients with high-risk SMM could prevent or delay time to progression to overt MM, given the activity of Revlimid/dexamethasone in patients with high-risk MM and the proven safety and activity profile of the combination of Empliciti and Revlimid in patients with relapsed MM.

The primary objective was to determine the proportion of high-risk SMM patients who are progression-free at two years after receiving the triplet. “The two-year time point was picked because we know that high-risk SMM patients in general have a 50 percent chance of progression at two years,” she said. The trial was originally designed with two arms, with one using high-dose dexamethasone and the other using low-dose dexamethasone. The latter arm was closed after enrolling just 10 patients due to similar activity and toxicity to high-dose dexamethasone based on published data demonstrating that high-dose dexamethasone, given once weekly, does not have a detrimental effect on the immune system in patients with SMM.

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Pomalidomide With Low-Dose Dexamethasone New Treatment Option for Multiple Myeloma

Pomalidomide, an immunomodulatory drug, combined with low-dose dexamethasone improved progression-free survival in patients with refractory or relapsed and refractory multiple myeloma compared with standard of care high-dose dexamethasone, according to the results of a multicenter, open-label, phase III trial.

Although prior research has shown that pomalidomide has efficacy in patients refractory to lenalidomide and bortezomib, it had not yet been compared with existing standard of care treatments in relapsed or refractory myeloma

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