As you may recall, for the past couple of weeks I have been languishing in a kind of oncological purgatory (or is it a limbo?), waiting to hear what the Hopkins oncologist thinks is happening with the myeloma in the wake of the stem cell transplant. When I didn't hear anything from him for a week after the 60-day followup tests had been done, I sent him a query via e-mail, which resulted in an out-of-office response saying that he had left town, might not be able to respond to e-mail in a timely manner, etc. This was followed by dead silence, until today, when I at last received a nearly ecstatic missive from him, the main points of which are the following:
1. He cannot recall seeing such a good response to a transplant in a myeloma patient. He thinks the tumor is completely cleared. I am not sure what led him to this conclusion, since the tumor itself was not biopsied, so I intend to interrogate him further regarding the evidence and reasoning behind this assertion.
2. His absence was in fact due to his attendance at a conference focused on bone marrow transplants, and amongst the presentations was one describing a recently concluded clinical trial, sponsored by the National Cancer Institute, that tested the efficacy of Revlimid as post-transplant maintenance therapy for multiple myeloma patients. More than 500 patients were randomly plied with either Revlimid or a placebo, over a period of 4-1/2 years. Half the patients getting the placebo started getting worse again within a little more than two years, whereas by the end of the trial, fewer than half of the patients getting Revlimid showed this "disease progression". These results are said to be "highly statistically significant".
3. His prescription, therefore, is that I should go on Revlimid maintenance. Of course this is a decision that must be made in consultation with the Christiana oncologist, and will be a major topic of conversation when I visit the latter next week. My understanding of "maintenance therapy" is that it would continue indefinitely, unless and until significant "disease progression" was detected, at which point presumably measures of some more drastic kind would have to be taken.