Posted by: Andy | October 13, 2007

Appointment Summary

Dad had his appointment with the oncologist Dr. Dushkin on Thursday. We arrived at 1 PM and waited about 20 minutes and then dad had to give blood (again). I think he should get used to this. After about 45 minutes we finally saw the doctor. She summarized the findings in the hospital and indeed confirmed 100% that we are dealing with multiple myeloma. The results of the bone marrow biopsy were conclusive.

 The type of MM that dad has is called IgA kappa. This is one of the rarer forms occurring in about 20% of cases. Dad had about 27% of his total plasma cells as abnormal. His level of the abnormal monoclonal protein was 6000 (6 grams) – which is fairly high. Normal is 100 or less. He also was suffering from hypercalcemia, renal dysfunction and lytic lesions on both femurs.  Concerning his renal function – his creatinine level (a measure of how well your kidneys are functioning) was 2.1. Normal is around .8 – 1.4. This is important and we’ll revisit this later. Dr. Dushkin’s first goal is to improve kidney function – and there is concern that adding more toxins (chemo, steroids) could further damage them, so she wants to be careful. Dad is not anywhere near needing dialysis – which would be indicated when creatinine levels reach 5 or 6.

One other measure is hemoglobin level – which was at 9.7. The normal range is around 14 or 15. This level is indicative of the severity of anemia and the doctor said it can take a while to get anemia in control. She wanted to start a treatment called Procrit – which is medication known as a growth factor – which stimulates red blood cell production. Dad got an injection of this before we left the office.

To help strengthen bones and lower calcium levels in the blood a medication called pomidrenate (a biphosphenate) is used. Dad had a single dose of this in the hospital and it will continue to be administered throughout his treatment. Once again Dr. Dushkin wanted to be careful with the dosage because of the risk of damaging the kidneys further. One possible side effect of biphosphenates is something called osteonecrosis of the jaw – which results in pain and inflammation. She had no major concerns about this possibility though. She also mentioned that Dr. Chawla (the orthopedic surgeon) would most likely recommend surgery on the left leg to insert a pin and stabilize the leg. She didn’t say exactly when but indicated it would be sooner than later. Radiation treatment on the leg will help to destroy the tumor and prevent further damage to the bone.

One last measure was something called Beta-2 microglobulin level. Beta-2 microglobulin is plentiful on the surface of white blood cells. Increased production or destruction of these cells causes Beta-2 microglobulin levels in the blood to increase. Dad’s level was 9.3 and normal is around 2.5.

Therapies

The intent of therapy in MM is to kill off the monoclonal proteins and to get the disease into remission with a first line treatment. There are no curative treatments and eventually it will come back and need to be treated again. How long that takes is not known and varies greatly from person to person.

With someone who is 70 or less and relatively healthy a stem cell transplant is also indicated – sometimes 2 in a row. Studies show that having 2 transplants back to back results in better outcomes than just having one. There are 2 types of stem cell transplants – autologous (auto) which comes from your own cells – and allogeneic (allo) which comes from a donor (most likely a brother or sister). In most cases your kids are not a match. There are major transplant centers nearby in John’s Hopkins and Maryland. In order to do the transplant you have to be in remission first.

Continued in next post…


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