High-Risk Relapsed Myeloma Update University of Colorado - April 16 2013

Met with Clay Smith, MD right on time. He is always such a good listener. We went over my lab values for today. My LDH is high at 367 (norms 98-192).

My Immunoglobulin G value is sky-high - NOT GOOD at 1247. Looks normal according to the norms of 700-1643), but my cancer is carried on the IgG. My IgG value was 3,422 on 18 Jun 2011 just after my initial diagnosis on 24 May 2011 prior to any treatment.

 My immunoglobulin is still way too low at 10 (norms 66-436).

 My immunoglobulin M is still way too low at <25 (norms 43-279).

My CBC shows white blood cells low at 2.3 (norms 4.5-11); ANC (absolute neutrophil count low at 1.00); hemoglobin low at 8.5 (norms 12-16); platelets very low at 39 (140-440); LDH 367 high.

 My Chem Panel shows mild kidney failure with creatinine at 1.28 (norms 0.52-1.04); BUN 18 (norms 7-17); and GFR 53 (norms > 60). My glucose is high at 192 (norms 70-112), but they won't want to intervene until the glucose exceeds 200. I can control the glucose by reducing my sugar intake.

I will have to wait for my SPEP myeloma test results, but since I'm a non-secretory patient, they are not that valuable. Dr. Smith wants me to schedule a bone marrow biopsy with Dr. Padavanija at St. Luke's Hospital in Twin Falls, Idaho as soon as I return to Idaho on 18 April

2013

He thinks my low wbc's, platelets, and hemoglobin are due to either too much pomalidomide suppression and/or my cancer plasma cells are unresponsive to the pomalidomide and growing uncontrolled and squeezing out the the normal bone marrow elements (wbc, platelets, and hemoglobin). Only a bone marrow biopsy will determine this.

For now, we hold the pomolidomide. So, I won't be on any chemo for now. Dr. Smith will also discuss with Dr. Padavanija raising the low threshold of hemoglobin for packed red blood cell transfusion. I'm not sure what hemoglobin value he was thinking of. Typically, they do not transfusion until the hemoglobin is less than 7.0. But, since I am symptomatic with shortness of breath, it merits raising the hemoglobin value for transfusion for me. Will give me more energy - hopefully.

If the pomalidomide is not working, Dr. Smith admitted that I'm in a "tough situation". If this is the case (as determined by bone marrow biopsy), I could look for a clinical trial somewhere that does NOT require total relocation to the trial location and see if they would accept me or I could opt to just stop all treatment. However, Dr. Smith warned that many of the clinical trials have minimum lab value requirements and I might not meet those at this time. He is will to help me with the clinical trial application if I go that way. He will also contact Mayo Clinic-Scottsdale for any suggestions they might have. I told Dr. Smith I didn't think I was ready at this point to stop treatment.

As far as the Dex 40 mg and spreading it out over 4 days goes - this is not optimal, but he said I could do it. Might want to switch to Prednisone in the same dosage taking it every other day. Will discuss with Dr. Padavanija.

Dr. Smith does not want me doing much until my platelets recover to at least 60 - currently at 39. (Norms 140-440). No riding the 4-wheeler.

Dr. Smith did a thorough physical exam and I told him about my left-sided neck and head pain and how it responded to migraine medication, Frovea. He worried it might be due to the low platelets and warned me about Fragmin use with such low platelets.

Discussed the right eye "floater" deal and he also worried that his was due to low platelets and encouraged me to see the ophthalmologist again if it changed at all. It persists as a brownish blotch in the shape of "Africa".

Just before we left, we met Dr. Smith's RN Sare.

All the snowy roads were dry on the way home to Greeley and we made it just before 4 PM...long day. Stopped for take out Chinese Food - yum!

Low Hemoglobin Requiring Transfusion From Pomalyst or Relapse or Both - April 10 2013

All day, Tuesday, 9 April 2013, I was short of breath and even had a difficult time getting from the sofa to the front door without sitting down quickly. My resting pulse has been in the low 70s and now as was in the middle 80s if I as perfectly quiet and lying down. Any standing or walking made my pulse soar to 100s and even 130. I have a little pulse ox finger machine and my oxygen level was fine in the high 90s...but, my heart rate was high causing the shortness of breath. I seriously wondered if I could even get myself anywhere.

I had a scheduled blood draw on Wed, 10 April 2013 at the Lost Rivers Medical Center in Arco, Idaho. My hemoglobin was only 7.5 (norms 12-16). They usually do not offer packed red blood cell transfusions until your value is 7.0 or below. However, a call to Dr. Padavanija at St. Luke's Hospital, Twin Falls clarified my situation. Since I symptomatic with shortness of breath and high pulse, she agreed that I needed 1 unit of packed red blood cells to bring my hemoglobin up which would reduce my pulse. 

I have to have any transfusion at St. Luke's Hospital in Twin Fall because I require irradiated blood products due to my previous 2 failed autologous stem cell transplants. The little Lost Rivers Medical Center cannot offer this.

My white blood cell count was low at 2.1 (norms 4.5-11); absolute neutrophil count (ANC) is low at 1.10 (norms 1.9 to 8.8); platelets very low at 43 (norms 140-440) and will continue Fragmin injections at half dose 7,500 units; LDH has come down some, but is still abnormally high at 913 (norms 313-618).

My chem panel was essentially normal except for my BUN which was little high at 18.3 (norms 7-17). My glucose was abnormally high at 173 (norms 70-112), but I'm on 40 mg of dex which raises the glucose and I probably ate too much sugar too.

The triage nurse at St. Luke's Hospital in Twin Falls advised that I try to get there as soon as possible for a packed red blood cell transfusion. So, at 10:30 AM, I started out on the 2 1/2 hour trip to Twin Falls, I may have exceeded the speed limit a tad and I made it in 2 hour hours 15 minutes. 

I was pooped when I arrived.

The Infusion Nurse Vicki accessed my Bard Power Port and sent a Type and Cross Match to the lab. After that was back, they ordered the one unit of irradiated Type A+ or O+ packed red blood cells. They sent Type 0+ Leukocyte Reduced. Again, I am thankful for volunteer blood donors that make this transfusion possible.

RN Rhonda ran the blood through a blood warmer and it took about 1 1/2 hours to run.

 Thankful that I have an implanted Bard Power Port and ever present MacBookPro.

This blood transfusion was only my 5th one since my diagnosis almost 23 months ago. And my only transfusion that was not during an autologous stem cell transplant. 

History of All Blood Transfusions Since Diagnosis May 24 2011

1. Apr 10 2013
2. May 16 2012
3. April 2 2012
4. Sept 22 2011
5. Sept 7 2011

We decided that I would go to Lost River's Medical Center in Arco, Idaho on Friday, 12 April 2013 and have my complete blood count repeated. Until then, I am to HOLD the pomalidamide (Pomalyst) and we will consult over the phone on Friday on how to proceed based on the lab values.

I complained of  a NEW deal happening in my right eye - where a brownish area with black pulsing dots was floating around in my right eye that I could not see through. Dr. Padavanija thought I should see an ophthalmologist as soon as possible and made an appointment for me for tomorrow at 10 AM. I was a tad worried about it and glad I could see a specialist so soon. Idaho is NOT like Colorado - specialty doctors are NOT on every corner and the norm is to wait for an appointment.

In the matter of an afternoon, I was a whole new person without shortness of breath, but I had a new weird thing in my right eye.  Really hoping it was related to low platelets, anticoagulation therapy, et.

Had no difficulty driving home 2 1/2 hours - had to wait for the train in Shoshone, but I was patient. 

I arrived home just before it started to get dark.

Pomalidomide (Pomalyst) Update For Relapse After 7 Doses - March 12 2013

Absolutely NO sleep last night - My gastrointestinal track has just STOPPED all of a sudden and I suffered all night. Took Senna-S and Phillips Tab - hope things start up again SOON.

Took half of my weekly 40 mg Dex for the day with breakfast (20 mg). Will take the second half with dinner since I take my Pomalyst at bedtime.

My GI tract started back up, but, I am still distended in my abdomen.

Update after first 7 days of pomalidomide (Pomalyst) 4 mg. Drove to Lost Rivers Medical Center in Arco, Idaho (30 miles each way) and had my blood drawn to see how my bone marrow is reacting to the new Pomalyst. They had not received my blood draw order from St. Luke's Hospital in Twin Falls, Idaho and I had to call them to get the order which came quickly, but lacked the LDH which should have been drawn - oh well.

My labs are not much different than before I started the Pomalyst 4 mg. My white blood cell count (WBC)  is low at 2.2 (norms 4.5-11 and reflects your ability to fight infection); ANC (absolute neurtrophil count  is low at 1.36 (norms 1.9-8.8 and reflects your immune system quality and whether you can be in public with or without a mask); hemoglobin low at 9.2 (norms 12-16 and reflects your oxygen carrying capacity or energy level) and platelets low at 97 (norms 140-440 and reflects your ability to clot your blood). I hope my platelets hang in there throughout the Cycle 1 (21/28 days).

My kidney function tests via my blood continue slightly abnormal. My creatinine is slightly high at 1.10 (norms 0.52-1.04); BUN is normal at 14.4 (norms 7-17); and GFR is abnormally low at 53 (norms > 60). My liver function tests are back to normal since I stopped plain Tylenol.

Drove back to Mackay and pretty much slept all day on the sofa...had to make up for that sleepless night.  Had a little gastritis, but nothing too bad.

The St. Luke's Hospital MSTI (Mountain States Tumor Institute) Pharmacist from Boise called today to ask me about any side effects that I've had from the Pomalyst. They have to report side effects to the manufacturer, Celgene, and they will be calling me each week. I explained that the only side effects that I could attribute to Pomalyst were:

• burning scalp (improving)
• creepy legs (had before I started Pomalyst, but seems worse at night – taking 1/4^th to ½ tabs of plain Oxy which helps. Trying to balance dosage so I don’t feel hung over during the day)
• increased neuropathy of left leg especially from knee to groin – was about a 2 (1-10 scale) prior to Pomalyst and now 4. I am attributing my left hip pain to neuropathy now since all of my tests (plain x-rays and MRI were normal).
• tired, especially after taking
• constipation (I forgot to tell her this, I will next week)

My neighbors this morning.

Pomalidomide (Pomalyst) Update For Relapse - After 2 Doses - March 7 2013

Day 1, 5 Mar 2013 I started on 4 mg of pomalidomide (Pomalyst) the evening of 5 Mar 2013. Just like Revlimid, I thought it best of take in the evening since Revlimid made me tired and pomalidomide is in the same family with Revlimid. 

I also took 40 mg of oral Dex (each tablet is 4 mg, so I have to take 10 for 40 mg). The oral Dex almost instantly cured my creepy leg syndrome, but it wasn't long before I had good case of gastritis going AGAIN. I took Carafate Suspension and that helped some, but the best cure for my gastritis is a slice of lightly toasted bread. I attribute the gastritis to the dex and not the pomalidomide. 

So far, I think the only side effect that I've had after one capsule of pomalidomide is being tired almost immediately after taking it. I slept well from 7 PM until 11 PM. After that I didn't sleep too well, but I stayed in bed and only watched television for about 2 hours around 1 AM.

Day 2, 6 Mar 2013 I had continued gastritis. Around 4 PM, my creepy legs returned with a vengeance which I'm pretty sure is from the pomalidomide and I had a frontal headache which I thought might be from our cloudy, off-and-on snowing weather today. I ate dinner early and the headache disappeared. Had another poor night of off and on sleep. I finally took 1/4 tab of oxy (a little medicine goes a long way with me) around 2 AM for my creepy legs and slept until 6:45 AM - this is good.

Day 3, 7 Mar 2013, gastritis. Up this morning, clear of thinking and don't feel hung-over from the 1/4 tab of oxy last night. Mild gastritis. No creepy legs this morning. I do have a burning sensation over the crown of my head, but it does not itch. I had a similar, but WORSE burning and itching when I started Revlimid, but it dissipated after about a week and never returned.

Summary of "maybe" Pomalidomide Side Effects:

• tired after taking
• very creepy legs
• burning scalp sensation

Approved for Pomalidomide (Pomalyst) For Relapse - March 4 2013

My medical insurance company approved pomalidomide (Pomalyst) with no copay for me today. FedEx will deliver the medication tomorrow and I'll get started on it 5 March 2013 for my recent relapse on top of my old relapse - haven't had less than 40% plasma cells in my bone marrow since 50 days after my 2nd autologous stem cell transplant which was done on 18 May 2012. Currently my bone marrow biopsy plasma cell count is at 60%. 

Let's hope pomalidomide (Pomalyst) works for me and I can tolerate it. I was unable to take Thalidomide when I was first diagnosed due to severe neurological side effects (unable to think or ambulate). I did fine on nearest relative, Revlimid. Initially, during induction prior to my 1st autologous stem cell transplant on 9 July 2011, I had a Revlimid itchy rash on my scalp and belly, but that quickly dissipated. Revlimid also causes diarrhea. Crossing my fingers for pomalidomide.... 

The MRI of my left hip and pelvis done on 28 Feb 2013 was negative, so I have no idea why it hurts.

Have enjoyed my almost 3 week chemo-free holiday since 14 Feb 2013. My gastritis is much improved. However, it is unnerving knowing my bone marrow is probably producing plasma cells as I type. I have taken dex during this time, but no chemo. And I continue on my Fragmin 15,000 units nightly injections.

Energy is up and I've been walking Kemmer almost daily. I was able to do my volunteer work with the Mackay Food Bank and I enjoyed that - even if I had to wear a mask!

Living in Relapse - January 31 2013

First, a little history - I was diagnosed with high risk monoclonal IgG Kappa multiple myeloma (4:14, 1q21 and other cytogenic changes) when I was 60 years old on 24 May 2011. Aside from anemia and 80% plasma cells in my bone marrow, I was in pretty good shape with normal kidney function and no lytic bone lesions. I was still pretty active, walking the dog in the mountains daily and doing anything I wanted – I was just SLOWER. I had recently turned 60 years old and I thought needing a daily nap might be just a part of aging.

I was prepared for an autologous stem cell transplant (ASCT) with both Velcade and Revlimid which didn’t quite get me to remission, so I required a 4-day hospitalization for VDT-PACE (Velcade, Dex, Thalidomide, Cisplatin, Adriamycin, Cytoxan and Etoposide) prior to donating my stem cells for the transplant which I had on 13 Sept 2011. After my transplant, I had TERRIBLE gastritis for months and developed a blood clot in my heart and it wasn’t as “easy” as it could have been…yet, I kept smiling.

I was so hopeful that I would achieve remission and 50 days post-ASCT my bone marrow did reflect remisson with an M-Spike of 0.1. Immediately, went on weekly maintenance Velcade and Revlimid, which didn’t feel like remission since I had to go for treatment twice a week and it wasn’t long before I relapsed in Feb 2012. Back to 60% plasma cells in my bone marrow and my high risk cytogenetic changes 4:14 and 1q21 persisted.

I was re-admitted for 2 courses of VD-PACE (Velcade, Dex, Cisplatin, Adriamycin, Cytoxan and Etoposide) and prepared for a second ASCT (autologous stem cell transplant), which I had on 18 May 2012. I never achieved remission afterwards and have been living in relapse ever since.

After my failed 2^nd ASCT, I’ve been treated unsuccessfully with Zolinza which did nothing for my myeloma and gave my kidneys a workout. My bone marrow plasma cell percentage went up to 60%.

Being run down from the 2 failed autologous stem cell transplants and no immunoglobulins,  it seems that I react to chemotherapy more deeply than most.

I was started on Carfilzomib, Dex, and Revlimid in Oct 2012.  My bone marrow plasma cells went down to 40% with persistent cytogenetic changes by the end Dec 2012. Added Cytoxan to my chemo plan and my counts plummeted, so that’s in a holding pattern for now.

In addition, I have non-secretory or hypo-secretory myeloma, which means the usual myeloma SPEP (serum protein electrophoresis) blood tests are not reflective of my bone marrow plasma cell percentages. This requires that I be followed by frequent bone marrow biopsies – I’ve had 9 in 19 months. Eight of the 9 bone marrow biopsies have been done without conscious sedation and I have finally convinced the powers to be that I REQUIRE conscious sedation for any future bone marrow biopsies.  Yippee.

So, back to living in relapse!  I'm been doing it for a year now. It is hard knowing each day that you have relapsed myeloma – constantly wondering how your bone marrow is doing, trying to stay off the internet surfing myeloma sites and blogs, yet worrying you might miss some new treatment for high risk myeloma…and simply wondering how much time I might have left. My oncologist already told me that I’ve lived longer than might be expected with my cytogenetic changes, but he added, no one knows. I’m lucky as the approval of new myeloma drugs seem to be coming along just as I need them. So, I keep smiling.

My continuing, weekly chemotherapy keeps me tired, but I try to keep up with my daily activities. I’m best after a dex day. Unlike many, I like dex – seems to give me energy and clarity of thinking that I don’t have otherwise. Unfortunately, the effect does not last.

I worry about getting something from others and I am good about wearing a mask around groups of people and always washing my hands. I have not been sick at all.  I have never been re-hospitalized for any infection. My kidney function returned to normal once all the Zolinza passed through my system and I’m careful to drink plenty of water each day. If I’m going to die, I want it to be of myeloma and not some dumb infection.

I’ve been in a rush to get my family genealogy organized and completed before my time is up. This project is huge and I enjoy it so much. While on the other hand, organizing my medical deductions for my 2012 Taxes is not much fun at all.

Walking my dog, Kemmer, is important to me and I try to do this daily. I like to shovel snow and I’ve been able to do some of that too. I take care of my own house and get my own meals. Trying to fight fatigue with activity, which helps. But, to be honest, right now, the thing I’m best at is “being one with my sofa” working on my laptop and watching television (I’ll miss football and I love golf)…so unlike my active pre-myeloma self.

I have no desire to travel out of Idaho, but do so for my transplant follow-up visits in Colorado. Plus, these trips give me a chance to visit with my former work colleagues. I love when my sister visits in Idaho and I hope she’ll come again soon.

I miss going to the Mackay School to volunteer and watch sporting events. If my Absolute Neutrophil Count (ANC) ever comes up near normal, I’ll return to the school, because I love the children. I’ve tried to keep up my Mackay Food Bank volunteer duties, but I let my Presidency in the South Custer Historical Society go along with my Secretary duties in the Mackay Women’s Club. I keep my Mackay Idaho 83251 blog going http://mackayidaho1.blogspot.com and my jm’s Adventure With Multiple Myeloma blog updated http://jmmultiplemyeloma.blogspot.com 

My mood is good. I don’t suffer from depression. I go to town each day and get the mail for my 92 year-old father. During this trip, I always visit with someone at the Post Office and I like that! Friends have been good about watching Kemmer while I need to away from Mackay. Driving 135 miles each way for my weekly 2 days of chemo is almost relaxing depending on the weather. I like to drive and it is a good thing since I spent 18,701 miles in the car during 2012 JUST for MEDICAL CARE. I’m retired with a monthly income and I have excellent heath insurance, so money has not been an issue.

So, I continue to live in relapse and for the most part – I’m doing a million!

2nd Relapse Confirmed By Bone Marrow Biopsy Done 17 October 2012

I received part of my bone marrow biopsy results done on the sample obtained 17 October 2012 at the University of Colorado Hospital this afternoon. 

My bone marrow reveals relapsed plasma cell myeloma with 60 % kappa monotypic plasma cells involving a slightly hypercellular marrow (70 %) with mild anemia (low hemoglobin) and moderate thrombocytopenia (low platelets). I do not have the cytogenetic analyses yet.

So, this report is even worse than I thought it would be with an M-Spike measured at UCH on 17 October 2012 of only 0.3. Plus, it is clearly apparent that the 2nd autologous stem cell transplant did nothing for me.

I'll just have to wait for the referral to Boston and the approval of Carfilzomib and Revlimid. I go to see Dr. Padavanija at St. Luke's Hospital MSTI in Twin Falls, Idaho tomorrow. If they don't have the Carfilzomib approval, I'll get Velcade again.

Snowing in our mountains today.

2nd Relapse Confirmed - Day 151 After 2nd ASCT - October 16 2012

I met Clay Smith, MD and Lindsay Davis, MD Fellow at the University of Colorado Hospital today and liked both of them. My sister, Jani, went with me to my appointment. I know I look too happy for a gal in her second relapse -- but, happy is better than sad.

As I suspected, Dr. Smith thinks I have relapsed based on my M-Spike of 0.4, increasing LDH levels, and increasing immunoglobulin G and wants to do a bone marrow biopsy tomorrow, Wednesday morning, to confirm the relapse. They also drew the SPEP tests today which take several days to get back.

Afterwards I will get my Velcade chemo, dex, and some fluids. My kidney function test done on my blood called creatinine, is sky high at 1.47 (norms 0.4 to 1.20) indicating that I have kidney damage of some kind, so they are going to give me fluids IV with my chemo today. I think the creatinine is up because of the Zolinza (vorinostat), but Dr. Smith thinks it may be due to the myeloma building up in my bone marrow. I probably should have stopped the Zolinza sooner.

My platelets are low at 80 (norms 150-400). However, my white blood cell count was fine at 4.3 (norms 4-11) and my hemoglobin okay at 12.1 (norms 12.1-16.3).

Since, Dr. Smith is sure I HAVE relapsed, he has already started the approval process for a the new multiple myeloma approved drug, Carfilzomib, aka Kyprolis, for me (it was only approved for use in July of this year - see link here Carfizomib aka Kyprolis). Dr. Smith will not wait the 7-10 days for the bone marrow biopsy results to be back. However, the approval for the drug may take 7-14 days. They called St. Luke's in Twin Falls, Idaho and I can get the drug there. It has to be given twice a week intravenously. I will also have to take Revlimid 10 mg orally and dex 20 mg.

I need to have some sort of intravenous access - a port in my chest or a PICC Line in my arm), but they are not going to do one because of my blood clot in my heart issues in the past – so, hope that my veins hold up for twice a week blood draws and the Carfilzomib. I will have to go back on the Fragmin (blood thinner) injections in my stomach daily (oh joy~) because of the Revlimid.

He also encouraged me to get a second opinion and gave me a couple of doctors to consider – one in Boston and one in Scottsdale, Arizona. He wants me to go see one of them as soon as it can be arranged after the bone marrow biopsy results are back in 7-10 days.

Technician Hank gave me an intramuscular flu shot in my right arm - it probably won't give me any immunity since my immuno system is still so depressed after 2 autologous stem cell transplants.

So, I will drive home to Mackay, Idaho this Friday, 10/19/2012 with Faye Hummel along to help me drive. She will fly back to Denver on Saturday, 10/20/12 from Idaho Falls.

I'll try to arrange travel for Jani and I to the 2nd opinion doctor.

It is official - I have RELAPSED - Day 184 Post 1st ASCT - March 15 2012

It is official, I have RELAPSED – my bone marrow has 50% plasma cells (cancer) --- better than the 80 % that I had at diagnosis…but, not good.

I will be admitted to hospital tomorrow for 4 days of  VDT-PACE (6 chemotherapy agents and steroids). 

Thalidomide po

Velcade IV

Thalidomide PO

Decadron IV

Cisplatin IV

Adriamycin IV

Cytoxan IV

Etoposide IV

Right now, I feel fine --- so, it hard to believe…but, it is what it is.

But, my PET Scan completed on 14 March 2012 was CLEAN!

Bone Marrow Biopsy Scheduled - March 8 2012

I saw Dr. Myint today and I have most likely relapsed with a m-spike of 0.59 (done in Idaho on 27 February 2012). Dr. Myint had all the labs including the SPEP repeated today at UCH and I will know the results early next week. I will have a bone marrow biopsy tomorrow morning. The results of the bone marrow biopsy will take 1 week and will be the main determining factor on whether I have relapsed.


Lab results for March 8 2012. Interestingly, my LDH and CRP are normal here at UCH today where they were high in Idaho. However, I've had 2 doses of Velcade/Dex 20mg since they were high on 27 Feb 2012.

However, an increase in my Immunoglobulin G to 818 is of concern to Dr. Myint. In this record overtime below, my auto-stem cell transplant was 9/13/11.

My white blood cell count was 4.2 on March 8 2012 and 3.5 on March 9 2012 (norms 4-11.1). My platelets are low at 129 on March 9 2012 and 118 on March 9 2012 (norms 150-400), and my hemoglobin is near norm at 11.4 (12.1-16.3).

Comprehensive Metabolic Panel March 8 2012.

Heading to Colorado Tomorrow

Dr. Myint does want to see me at UCH and I will drive to Colorado from Idaho tomorrow, 680 miles to Greeley where I will stay with Jani and Robbyn again. My appointment with Dr. Myint is at 4:30 PM Thursday, March 8 2012.

M-Spike on the Rise - Day 167 Post 1st ASCT - Results from February 27 2012 SPEP

My m-spike value has increased to 0.59 on 27 Feb 2012 from 0.15 on 15 Jan 2012.  I was 5/12 months post stem cell transplant (Day 167 Post 1st ASCT) at the end of February 2012 (autologous stem cell transplant on 13 Sept 2011). This value most likely represents RELAPSE. 
I called my transplant nurse coordinator at UCH, Lindsey McMenimen. Lindsey will share the results with Dr. Myint and the bone marrow team on 6 March 2012 at their weekly patient update meeting and call me later with their plan. I am not happy about the increase, but plan to adjust one day at a time - multiple myeloma is a tough cancer to have. I continue to feel pretty well with the exception of some mild back pain and shingles pain. I'm on Day 8 of 14 of Revlimid 10 mg and I had Velcade subcutaneously yesterday along with 20 Dex intravenously.