Monday, July 20, 2009


First, I am neutropenic. I know this because I am utterly exhausted. It started to hit me yesterday afternoon when I was inexplicably dragging. By now, it's all I can do to stand up. But this is par for the course and I'm not going to be concerned about it.

Second, that Lasix (the drug that induces urination to release the retained water) does work but it happened over several days, not the terrifying dam-bursting situation that I thought was going to occur. This has been hell on sleep, because I'm constantly getting up to use the bathroom, but I have lost 8 pounds in two days and have only 3-4 more before I am back to where I was before this last round of consolidation chemo.

Now...with that out of the way...the exciting news. Bear in mind, this is based on the blood draw from last Thursday, the 16th, so it doesn't reflect the full impact of this cycle of chemotherapy.

I'll give it to you straight from the lab paper: "Trace M-protein is present in low quantity in the gamma-region but cannot be accurately quantified due to presence of other immunoglobulins."

Some quick translation here. Immunoglobulins of different types -- called gamma, alpha, beta, etc. -- are present in the blood. Different flavors of myeloma can affect each type of plasma cell. I have the most common form of Myeloma, IgG (immuoglobulin gamma). Meaning that the "gamma" immunoglobulin in my blood contains both "good" immunoglobulin created by healthy plasma cells, as well as this monoclonal "bad" protein created by the cancer cells. So when they are looking in the "gamma region" for the M-protein, they are saying that within the gamma protein, there is some of the bad protein, but that there isn't enough to accurately quantify exactly how much. The margin of error of the test is probably greater than the amount of the protein!

"Trace" sounds very low indeed! Not zero, but very low. It's unclear if this is less than 0.1, or simply less than some other arbitrary number at which they stop measuring (could be anything lower than 0.4), but it represents a clear response to consolidation. As I mentioned there were two more days of chemo after this pull, plus more Velcade, thalidomide, dex, etc. So with any luck, I will be even lower right now. It seems to me they wouldn't arbitrarily cut off at 0.4 -- I would think "trace" means one less significant digit or something like that, but there's no way to know for sure (until I pester BB about it later in the week).

We will know more from today's blood draw on Thursday, which is when I am also going to be visiting with BB. In the meantime, I will have daily lab visits and hopefully a quick rebound from neutropenia. With luck, the data on Thursday will be even more definitive than this information.

Certainly this trajectory is a positive one -- I am headed in the direction of CR, which as you know I have been somewhat fixated upon. :)

The strata, one more time:

Very Good Partial Remission -- normal marrow under basic analysis, some residual M-protein (this is where I was)
Near Complete Remission -- as above with no residual M-protein under electrophoresis (the standard test)
Complete Remission -- as above with no residual M-protein under immunofixation (a more sensitive test)
Stringent CR -- as above with normal marrow under immunofluorescence (very sensitive test)

Thanks for all the well-wishes, prayers and support. I will keep focused, and keep you posted!


  1. Congrats!!! That is great news...

    A question...are their trace amounts in the general population?

    I am soooooooo happy for you.

  2. Jan -

    Many people in the general population have trace levels of the protein, however that would be (I think) considered MGUS...monoclonal gammopathy of undetermined significance. Once MGUS develops into MM, there is no return to MGUS. Because the significance is, in fact, determined. It is Monoclonal Gammopathy that Will Turn Into Myeloma And Kill Ya Dead If You Aren't Careful, or MGTWTIMAKYAIFAC. :)

    Thus, trace levels are a path on the way to no level. But I have renewed confidence, since the residual levels did respond to the chemo and they didn't simply chip away from 0.4 to 0.3 but made a big dent. There should be further response, and then I will have powerful maintenance therapy for three years.

    Of course this is one test, and variability from test to test can certainly swing, so I don't want to get ahead of myself. But the plateau has been broken through. I hope Bruce is feeling well!

  3. Good news indeed! I knew you were fading hard!

    When reading MGUS, all I can think about is ROUS (Rodents of Unusal Size), but I don't think they exist.

  4. YAAAAAAAAAAAAAH! I am so happy for you. GREAT GREAT news. It'll only get better. Keep believing.

  5. Nick;

    I'd bet your M-protein is below 0.1. I recently received a similar lab report and my previous readouts had been back to back 0.1s over a period of 30 days. My reports always acknowledge the previous measurement to compare with the most current level.

    Congratulations to you and your medical team.

  6. How fabulous!! Intending that the news continues to be confirming your greatest desire...

  7. Congratulations! We are thrilled for you and pray you continue to get great news! Much love, Julie & Mike

  8. See you are well on your way Nick! Watching the Tour I'm imagining you cycling up the climb through the cheering crowd!