Sunday, July 17, 2011

Recent Developments

This past week the oral surgeon received the results of the CTX test, so I travelled to his office to discuss the situation with him. My score on the test was 175; anything over 150 means that the risk of ONJ is minimal. He is therefore willing to extract #27. We discussed the replacement options, all of which strike me as unpalatable (pun intentional), other than the implant. Of course an implant carries with it risks of its own: the bone may not bond with the implant; the gum may not heal and/or may become infected; nearby teeth, nerves or muscles may suffer collateral damage. Having watched the educational video on the subject, I scheduled the extraction for August 1. Gulp.

Meanwhile, the oncologist has changed my chemotherapy regime. We discussed the concerns about prolonged Revlimid exposure leading to additional hematological cancers, and he offered an alternative protocol involving a lower dose, in exchange for giving up the one break week in four. I'm going for it. I'm hoping that eliminating the break week will allow my digestive tract to figure out what it is supposed to be doing; after more than a year, it has never gotten used to the switching on and off. The old 25 mg Revlimid capsules were large white oblongs; the new 10 mg capsules are smaller, half blue-green, half pale yellow.

The oncologist took the opportunity of this discussion (and the recent two-year anniversary of my diagnosis) to remind me that, although the trials establishing Revlimid as a maintenance therapy showed significant delays to post-transplant progression, they could say nothing about its ultimate effect on survival, vs. waiting for progression before hitting the cancer with it. That's because they stop too soon to show that. One would have to drop Revlimid on the patients in the placebo group after they showed progression, and then continue to follow the entire group until death. No one can wait that long to find out the answer, so I am part of the de facto clinical trial that will ultimately determine it.

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