Wrap Up

Today was the exit interview, where we talked about the schedule going forward, and interpretation of the latest numbers for assessing how well I responded to treatment. The plan is to begin maintenance/consolidation chemotherapy, similar to the induction chemo I was doing pre-transplant, at about day 60, which will be mid-November. Also at that time I will start on my "childhood" immunizations, which I need because my immune system has undergone what amounts to a "factory reset."

In terms of how I am doing right now, I basically sailed through both transplants without a single really bad day. I'm grateful for that, but am more focused on what's left of the disease at this point. The truth is it's a little hard to say--which is a good thing.

The disease is caused by proliferation of a single lineage of plasma cells. Plasma cells are responsible for making components of antibodies--each lineage just makes one part of the molecule--so you can assess how much disease there is by looking at the ratio of the component that the tumor cells are making to the other (normal) components. When people are first diagnosed with myeloma, the ratio is often 100 to 1 or higher. After treatment, a ratio of 1.0 should mean no measurable disease. Some people actually achieve this, although I haven't yet. One problem with ratios is that when the numbers are small, ratios are unreliable--so measuring how much disease is left gets harder as the amount of disease goes down.

Responses to treatment for myeloma get translated into a set of categories: complete response, very good partial response, partial response, stable disease, progressive disease. They're fairly broad categories, but they are clinically useful. My response, right now, would be classified as "partial response," falling just shy of a "very good partial response." I think of it as "pretty good partial response" although obviously that's not an official category. So the target for post-transplant chemo is going to be that small amount of residual disease, and the new drugs that are available make that seem like a reasonable hope.