Diagnosis, Staging, and Treatment Plan June 6 2011

My multiple myeloma is officially diagnosed as Stage 1 IGG Kappa Myeloma complicated by two significant cytogenetic DNA chromosomal changes 4/14 and deletion of a part of 13. This combination of chromosomal changes usually predicts an unfavorable prognosis.

However, my oncologist, Dr. James Moore,  is very optimistic and wants to aggressively treat the 80 percent neoplastic cell involvement in my bone marrow at present.

I will have a PET Scan of my whole body this week – results will help in following the improvement with chemotherapy.

I will have a port surgically implanted in my chest this week (they put you to sleep) so they will not have to access my blood via my arms and hands and have a port to give the chemotherapy through.

I will begin chemotherapy on Monday, June 13^th (most probably). It will consist of intravenous Velcade and Decadron. I’ll also be given an intravenous dose of bone strengthening medication called Zometa once a month. The Velcade and Decadron schedule of medications will be intravenous on day 1, day 4, day 8, and day 11 of each 30 day period.

Hopefully, I’ll be taking Revlimid in pill form after my medical insurance approves the very EXPENSIVE drug. The insurance paperwork for the Revlimid could take up to 2 weeks. However, Dr. Moore does not want to wait for the Revlimid to begin the Velcade and Decadron. I would take the Revlimid day 1 to 14 each 30 day period.

These chemotherapy agents do not cause hair loss and are generally well tolerated – mostly make you tired. He said many of his patients on these drugs drive themselves to their chemo appointments.

I will also have to take Acyclovir 400 mg by mouth twice a day to prevent a recurrence of the shingles I had in August 2009. 

I will continue the chemotherapy agents twice a week for 2-4 months (30 day periods) and then have a autologous bone marrow stem cell transplant (where you donate your own bone marrow stem cells for the transplant) at the Anschutz Cancer Center at the University of Colorado in Aurora, Colorado.

My kidney function is fine for now and I have no known fractures.

I will plan to stay here in Greeley, Colorado with my sister, Jani and Robbyn. They are both very supportive. I will have all my chemotherapy treatments in Ft. Collins at Dr. Moore's office and the port  procedure at Poudre Valley Hospital in Ft. Collins.

So, that is what I know for right now. Thanks for your concern.

Here is Team jm at the appointment.with Dr. James Moore -  Jani, jm, and Dr. Nancy White. I'm lucky ro have so much support.

Here is the official bone marrow biopsy results from a lab in California called Genoptix. Click twice on it enlarge for reading.

1st Bone Marrow Biopsy done 24 May 2011 and resulted at GENOPTIX in Carlsbad, California on 3 Jun 2011.

CLINICAL DATA:

60-year-old female with anemia and monoclonal gammopathy. Evaluate bone marrow for multiple myeloma.

Accompanying CBC report date 5/24/11, indicates WBC 3.4, RBC 3.20, Hgb 10.3, MCV 93.2, MCH 32.2, MCHC 34.5, RDW 15.9%; platelets 174 with a differential count of neutrophils 41.3%, lymphocytes 47.9%.

FINAL DIAGNOSIS: Plasma Cell Myeloma with Unfavorable Prognostic Factors

Comprehensive Assessment:

Review of the bone marrow study shows hypercellular marrow with sheets of neoplastic plasma cells seen (approximately 80%) replacing the marrow elements. The plasma cells are, by flow cytometry and IHC staining, kappa light chain restricted. The plasma cells show atypical morphology, and occasional plasma cells show plasmablastic morphology, however, significant plasmablastic cells are not seen on the aspirate smears. Cytogenetics show norma female karyotype. Myeloma FISH shows t(4:14) and deletion 13. t(4:14) is associated with an unfavorable prognosis in plasma cell myeloma.  The presence of these risk factors for plasma cell myeloma should be interpreted in the context of all other established prognostic clinical and laboratory parameter.

Morphology:

Bone marrow aspirate, core biopsy, and clot sections:

-Plasma cell myeloma (approximately 80% marrow involvement)

Peripheral Blood:

-normocytic/normchromic anemia

-mild leukopenia

Flow Cytometry:

Monoclonal plasma cells detected (~20% of the nucleated cells), consistent with plasma cell myeloma.

Cytogenetics/FISH:

Cytogenetic analysis reveals a NORMAL female karyotype without apparent clonal aberrations.

Myeloma FISH reveals ABNORMAL results with t(4:14) and -13. FISH analysis utilizing probes specific for aberrations commonly associated with myeloma including t(4:14), +5, +7, +1 1q, t(11:14), -13, 13q-, t(14:16) and TP53 (17p-) is performed. These studies detect monosomy 13 in 23.5% 947/2000 and FGFR3-IGH @ fusion signals in 12.5% (25/200) of nuclei examined. An extra IGH signal is seen in an average of 9.75% (39/400) of nuclei examined, which supports the t(4:14) findings. The t(4:14) is associated with an unfavorable prognosis in myeloma.  The remaining probes do not detect aberrations in the 200 nuclei/probe examined.