Friday, July 3, 2009

Good enough for Michael some questions

So it's all over the news. Michael Jackson was allegedly taking Propofol for insomnia, of all things. This is the drug that they damn well better be giving me before the FNA and the bone marrow next week. If I am lying on the gurney getting ready to be wheeled in to the interventional radiology room with that snake handling maniac doctor, and they aren't going to give me Propofol, I will get up and walk out, it's as simple as that.

Meanwhile, I've been compiling some questions for BB (some of which I will also ask SF, in the odd chance that I get the opportunity to speak with him before going back to Arkansas).

1. My understanding is that the success rate of getting people into complete remission using thalidomide and dex for several cycles is quite high; adding Velcade to the mix should make it even higher -- perhaps close to 100%. Should I not have undergone more induction and thus put myself into remission, or close to it, BEFORE the transplants? If not, why not? What is the rationale for doing the transplants BEFORE the best possible reaction from induction therapy is reached?

2. Since it is better to achieve CR than not (there can be no such thing as "event free survival" when I have an ongoing event), given that I responded to induction, with the benefit of hindsight would I not have fared better with a second cycle of induction? [This question is close to the first one but gets directly at the potential shortcoming of the Lite arm of TT4)

3. If I do achieve CR now, given that I've already had the transplants (versus having them after remission has been achieved), is my CR less quality than would have been the case? Other doctors have described the transplant as a means of eradicating any cells left over after induction has created remission. Obviously in Arkansas the transplants are used as part of active therapy, not consolidation. What is the biological benefit to this?

4. If I respond to consolidation but I do not yet reach complete remission, can I get a second cycle of consolidation? If not, why not?

5. Of those enrolled in TT3, how many achieved remission AFTER consolidation? And how is their event free survival rate and sustainability of remission relative to those who achieved CR BEFORE consolidation?

6. Of those enrolled in TT4, how many achieved CR in the lite branch versus the standard branch?

It's hard to imagine answers to these questions that would put me at ease, frankly. But BB is a confident person, to say the least. Listening to my initial consult with him again, it reminded me of why I went there. I asked him "what's the typical treatment plan for a recurrence" and his response was "the likelihood of recurrence is so small, we don't have a typical program."

So perhaps he can answer the questions above very clearly and confidently...we shall see.

I called SH's office to try to get my results of this past Tuesday's blood tests, but they are closed for the holiday. So I shall have to wait until Monday to find out if my M-spike stayed at 0.3. And then on Tuesday, it's back to Arkansas. More news as it becomes available.