pomalidomide (cycle five)

This week I am completing the fifth twenty-eight day cycle on pomalidomide and dexamethasone. In the middle of the month I had my regular blood work which showed that the free light chains had dropped for the first time in a few cycles. They are now at 214. While this is good news the number is still higher than my hematologist would like in order to lower the risk of organ damage due to amyloidosis. He advises that we add cyclophosphamide to the treatment. This is in pill form, taken once weekly. I will receive a low dose and should not experience any additional side effects. I received cyclophosphamide for six months while being treated with bortezomib (Velcade) in the fall of 2013. The hope is that this will increase the effectiveness of the pomalidomide (Pomalyst) and dexamethasone. By the way, pomalidomide is now being funded by the BC government's cancer agency. Good news! In my case, I will continue to receive it through the compassionate access program of its manufacturer, Celgene.

Speaking of side effects, I have noticed that the increase from 2 mgs of pomalidomide to 4mgs daily has paralleled with an increase in aches and fatigue. Once the increased energy that comes with the dex wears off after two days I find myself not feeling well for much of the rest of the week. I realize that side effects of chemo can be a lot worse ... still, its disappointing to find the aches and fatigue returning on schedule every Wednesday. While the side effects of dex (sleeplessness, hyper-activity, weight gain) are not wonderful I am appreciating the predictable two days each week free of ache and fatigue.

I am up bright and early today because it is Tuesday (on Mondays I take my weekly whack of dex which makes sleep challenging on Monday nights). In awhile I head off to St. Paul's Hospital for a regular IV infusion of pamidronate to strengthen my bones. It happens every twenty-eight days. My next pamidronate appointment falls on June 23, my final day of work after thirty-five years. Just twenty-eight days to retirement! This weekend I am off to Whistler where the general meeting of BC Conference of the United Church will be held. Over the years at the conference meeting I have been watching the retirees as they are recognized and thanked. It is hard to believe I am now one of them (the meeting will be live streamed, with the recognition of retirees scheduled for Friday evening at 7 pm Pacific - the live-streaming link will be available at BC Conference of the United Church of Canada).


  1. I read your post with some interest, as I am on Pom as well with dex. But, after one cycle no change in my KFLC, and my neutrophis have taken a while to reboot. Have you had any issues with Pom?

    1. Hi Christina,
      Good to hear from you. I just updated my post noting the side effects I have had with pomalidomide. At first it did not change my free light chain count. I began at a half dose because of a reaction I had to lenalidomide. When we increased to full dose the pom held steady, and then slightly reduced, the free light chains. My neutrophils have held steady throughout. I hope that your next cycle shows improvement in your light chain count.