velcade - cycle eight

I am now half way through my eighth and final cycle of this set of treatments on bortezomib (Velcade) and dexamethasone. After this cycle is complete on January 31 we will stop treatment and wait to see how long it takes for a bio-chemical relapse (an increase in the levels of my free light chains). I am looking forward to at least a couple of months without any treatments. The side effects from the treatments are minor but they do occur and the weekly trips for blood work and for injections are time consuming, so having normal weeks without any treatments will be a gift.

Yesterday I received the final results from cycle seven. The good news is that my kappa free light chain count dropped to 43.The results from July through to late October had been hanging around 100. In early December the number fell to 80. So dropping to 43 this time around is a big drop! The normal range (the one that would be expected if someone without myeloma had this test) is between 3.3 &19.4 so I am getting much closer to normal from my first readings in May 2011 of over 1600.

Recently I learned that my particular type of myeloma - Free Light Chain Myeloma (also called "Bence Jones Myeloma") - is found in only ten percent of those diagnosed with myeloma. Most myeloma is an over-production of the long or heavy chains in the plasma cell. Think of the plasma cell as a "Y" made up of two long "Y" pieces paired together with two extra short pieces - or chains - attached to the short ends of the "Y". The long chains are the two long pieces that pair up and form the "Y", the short chains are the extra pieces that link up in parallel with the short parts of the "Y". Most people with myeloma have an over-production of one long chain paired with one short chain. These are easier to detect in the blood because the kidneys cannot filter them. Long chain myeloma causes "M" spikes or "monoclonal spikes" that show up in blood work. They are called monoclonal since the cancer is an uncontrolled cloning of a single - mono - chain rather than of the complex chains that are supposed to be made. In my case I have an over-production of one of the short or light chains - still mono-clonal but the M-spike is hard to detect in the blood. It mainly shows up in my urine. Normal blood tests don't easily detect this kind of myeloma (even, until recently, the specialized test called serum protein electrophoresis that I have monthly and that once could detect my myeloma but currently cannot see it). However, there is now a very accurate test for free light chains in the blood and it is the one that the doctor is using once every thirty five days to keep track of the level of the faulty plasma in my blood. There is a helpful guide about all of this at Myeloma Canada.

So it continues to be good news for me. Things are under control. After I stop treatment at the end of the month my doctor and I expect that my numbers will, at some point, begin to rise. That will lead to further treatment. However, given the good response that I have had to Velcade there is a good chance that my numbers will stay low for some time. If they don't rise right away that will be wonderful news and we will just watch and wait to see what happens. In the meantime, I continue to be grateful for the care I am receiving.