Today I finally met with Dr. B again. I haven't personally seen him since my initial evaluation in early February. I only met with the PA when I was here for induction since Dr. B's schedule was pretty tight and he was ill when I was ready for discharge. I was definitely anxious and excited to meet with him to hear the results of the restaging tests and get his perspective on everything.
I'm not sure how much I've talked about the good doctor before, but I can't count how many people have used the expression "he's quite a character" to describe him. While I absolutely think that's true, I also think it deserves some elaboration. My guess is it's partially due to his choice of attire, and partially due to his personality. As motorcycle enthusiast he often sees patients wearing a black leather motorcycle jacket (today it was accompanied by a turquoise scarf). As far as his personality, although he's a character, I definitely wouldn't characterize him as eccentric. He's very warm and personable, but also a bit edgy (if that makes any sense). He likes to laugh and joke and tell stories and generally just not act like many doctors I've met before. He always gives a hug and kiss on the cheek to greet and it feels more like seeing a family member than a brilliant and highly esteemed doctor. Then once you get down to business and he looks at your chart he flips through the piles of paperwork and summarizes everything succinctly and usually manages to answer most of the questions you meant to ask him before you even get a chance to ask. In short, I think he's great. (I do realize I could be a teeny bit biased!)
Now on to the meeting. Once I arrived at the clinic, they checked me in and took my vitals then the nurse came in to make sure everything was in order with my chart and my scheduling. She told me to restart the supportive medications I had stopped when I was discharged, and she handed me the results of all the restaging tests for my own records. Then they took me down to where Dr. B's office is on the 4th floor. It was a little bit of a wait, as there were a couple of people ahead of me. It went quickly though and within 35 minutes or so I was in his office waiting for him. I got my iPad set up to record the audio of the meeting, and I also had my cell phone out so we could get Alex on the phone from back home.
Some other guy came in and sat down in an extra chair behind the desk. He didn't say anything and was never actually was introduced to me so I don't really know exactly who he was. Dr. B came in a few minutes later and gave me a hug and kiss on the cheek. He commented on the iPad..."Ahhh this is the hot new thing!". I told him I was going to use it to record, and he claimed he doesn't know the first thing about "all that stuff". He told the other guy that he was going to have to get one and teach him how to use it. After that, I dialed Alex and we got started.
He flipped through my chart and concluded "I'm very pleased"...and boy, I'll tell you, this is EXACTLY the thing you want to hear coming from your oncologist!! Then he proceeded to talk through the results and where everything stands. There are several markers we are looking at to track my progress and response to treatment. First is the light chain, which is a measure of the proteins my abnormal plasma cells are making. Plasma cells make antibodies, but my myeloma plasma cells are only making parts of antibodies...called light chains. In most people myeloma cells make lots and lots of full antibodies and these are a little easier to monitor. My myleoma is "hyposecretory, light chain restricted", meaning my myeloma cells make relatively small amounts of only the light chains instead dumping huge amounts of full antibodies. The normal range for light chain in the blood is 0.33-1.94, so the goal is to get back within this range. Before treatment my level was around 19, and now it is down to 3.95! Good progress for sure!
Another thing we are looking at is the bone marrow biopsy results. As myeloma progresses plasma cells tend make up more of the cells in the bone marrow than usual. Healthy bone marrow is comprised of about 5% plasma cells, and >10% is diagnostic for myleoma. It's important to note that this characterization isn't differentiating between normal and abnormal plasma cells. In other words, in a person without myeloma all the plasma cells are normal, but in a person with myeloma you see a mixture of normal plasma cells and cancerous ones. Prior to treatment my bone marrow was 15% plasma cells, and now it's down to "5-10%", so I'm back in the normal range! I'm also still within the Stage I categorization according to the International Staging System (beta-2 microglobulin = 1.6 and albumin = 3.7).
Aside from the light chain and the bone marrow the only other thing we are tracking is the focal bone lesions. The goal is for these to heal up and disappear from the MRI. The latest MRI showed all the lesions are stable....no new ones, and none have gotten bigger, which is good news! At this point this is the expected result, as it takes time for bone to rebuild. We just hope they start to get smaller over the next few months, but according to Dr. B it could take 10-12 months for them to resolve completely
So all in all it's good news...I'm responding well to treatment!! Dr. B was happy with the results and was pleased that I tolerated the induction course with so few side effects. The best part of the meeting was when he was dictating his conclusions, he said "patient has almost achieved a complete response from induction therapy". In myleoma speak a "complete response" essentially means remission. I must have been grinning from ear to ear to hear that I was "almost" there. Now I know that even once I achieve a complete response it will still be important to heal up all the lesions (because things are more likely to restart in the lesion areas), but it's still very encouraging to hear things are going well so far.
I also had the pleasure of running into the husband of one of my fellow patients who was on about the same course as me on the last visit. She was one of the ones who was ready for collection as I was finishing up. He gave me a huge hug (I still smell is cologne on my shirt!) and we chatted for a few minutes about my progress and that of his wife then he had to go run and meet her. I'm looking forward to catching up with them over the next couple of days.
So now we're on for the transplant to begin on Thursday! I get my new central line tomorrow morning, then Alex arrives in the afternoon. My first dose of melphalan is scheduled for 9 am on Thursday.
I'll give a recap tomorrow of how the transplant will go. The unusual thing about doing here is that it's all done outpatient. Most institutions lock you up essentially in isolation while your immune system is knocked. I've already stocked up on hand sanitizer and masks. :)
