A new study (see: http://tinyurl.com/ydambjq) has showed that women who regularly practice yoga have reduced levels of the cytokine IL-6, which, as we know, is a major myeloma growth factor and has also been implicated in heart disease, stroke, type-2 diabetes, arthritis and a host of other age-related debilitating diseases. Well, well, this is very interesting. Please go have a look…

Okay, that’s it!, this Science Daily article has inspired me to get off the computer and go do some qigong. The research I am doing for a bunch of different posts can wait…Ciao!

An amazing story (watch the video): http://www1.whdh.com/news/articles/local/BO133130/

A blog reader, thank you!, sent me a link to a Myeloma Beacon article (see: http://tinyurl.com/y86k9py) on papain, an enzyme contained in papaya fruit trees, which breaks down proteins. One such protein, called fibrin, makes up the protective layer of cancer cells. Papain degrades fibrin and damages this protective layer, making the cells more susceptible to immune response or chemotherapy. The compound also hinders tumor growth and prevents it from spreading to other parts of the body.

Please go read the rest of the story. Interesting…

My only experience with papaya was dreadful, to be honest…but makes for an amusing tale, so here goes. A few years ago, when I was experimenting a lot with veggie and fruit juices (using my fabulous Greenstar juicer), I bought a couple of organic papayas. Now, I had read online that it was best not to juice the seeds because of their extreme bitterness, but hah, Margaret knows best!, so I washed, cut up and shoved everything down the juicer shoot, figuring that the sweetness of an apple would lessen the bitter, er…impact. Well, it didn’t: my lips puckered, my face puckered, even my hair puckered…haven’t bought a papaya since…but after reading this article, I will!

This time, though, I will remove the gazillion and a half seeds contained in each fruit…

P.S. There is a list of the most recent blog reader comments at the bottom of my Page column (scroll down, look on the right). This is handy if, like me, you like to read comments even on older posts, which brings me to the point: if anybody has any experience with MRIs and gadolinium, please click on and answer Francesco’s comment (or see my December 13 2009 gadolinium post). Thank you!

Premise 1. Stefano stores his palm pilot (a sort of fancy flat cell phone with all sorts of neat features) inside a nice black cloth bag with a drawstring (see photo 2).

Premise 2. Peekaboo loves socks (photo 1)…so much so that I always have to be careful to put away our clean laundry immediately, or the socks will disappear…sometimes for weeks. Peekaboo, you see, will go through an entire pile of laundry just to pick out the pairs of socks, which she then carries off proudly, tail straight up in the air, head held up high (funniest thing to watch). I thought I was being oh so very smart when one day I presented her with her own pair of clean (but old and a bit tatty) pair of socks, tied just the way she likes them…but no, she is not easily fooled. She prefers the smell and feel of freshly-laundered socks. Oh well…it’s a small price to pay to have such an adorable little creature in our lives…

Premise 3. I am almost positive that Peekaboo has secretly been reading and getting ideas from the first Simon’s Cat book that I gave to Stefano for Xmas…

The Story. On Sunday morning, Stefano couldn’t find his palm pilot anywhere. We searched the entire house for it, upstairs, downstairs, under things, on top of things, inside drawers, everywhere. It was gone. Vanished. Poof! He was understandably very upset…then, in late morning, he found it lying on our dark living room rug, still inside the cloth bag (photo 2, on the left). Phew, close call. We could have easily stepped on it by mistake…

Well, he figured out what had happened. The previous evening he had left his palm pilot on the top shelf of his tall bookcase in the attic. During the night, Peekaboo must have spotted it and taken it for a pair of socks. Somehow our little monkey climbed all the way up to the top shelf…

She then carried the palm pilot down two flights of stairs to the living room (we live in a row house) without harming it in any way. I tell you, she is very careful with her “socks”!

But here comes the best part of the story…

Later on that day Stefano got a rather puzzled call from his brother who asked: “hey, ciao, did you call me very very early this morning?” Stefano replied, even more puzzled: “No, I didn’t.”

Then it dawned on him.

Peekaboo had made the call…

At the end of my December 17 2009 post, I mentioned a study that I was reading. It is titled “How I treat multiple myeloma in younger patients” and was published in “Blood” in October 2009. It doesn’t have an abstract, but here is the link: http://tinyurl.com/yan57ow (By the way, many thanks to Sherlock for sending me the full study…)

Before we begin, let me just say that there now seems to be a trend against treating stable smoldering patients too early. Last fall, for example, I heard Dr. Durie speak of the potential dangers of prematurely treating stable asymptomatic patients, and this is confirmed by the authors of the above-mentioned study, three well-known MM specialists who, incidentally, openly declare their general propensity for very aggressive treatments in the case of younger myeloma patients (=full-blown MM, not SMM, patients, mind you). 

I thought that the following paragraph was rather extraordinary, especially when you consider that these three specialists do not believe in “saving drugs for later” but prefer, whenever possible, the gung-ho “throw everything but the kitchen sink” approach: Although the activity of novel agents has advanced to the point that early interventions are now being explored in clinical trials for smoldering myeloma, there is still no evidence that early treatment will improve survival in asymptomatic and biochemically stable patients. A critical point is that up to 25% of smoldering myeloma patients will not require active treatment for 10 to 15 years, although the majority will in fact progress during that time.

As far as I am concerned, the key point in this paragraph is: […] there is still no evidence that early treatment will improve survival in asymptomatic and biochemically stable patients. But what about that “critical point,” indicating that the majority of SMM patients will progress to active MM within 10-15 years? On what is that statement based?

Well, it turns out to be based on the 2007 New England Journal of Medicine study that we have already discussed here (see my Page titled “SMM-MM risk of progression” on the right-hand side of this page). If you would like to see the full NEJM study, click here: http://tinyurl.com/c9f8lb

Without repeating what has already been discussed on my blog, I would like to go over a few points:

1. the NEJM study looked only at 276 smolderers, which is hardly a huge number, when you consider how many smolderers there must be…on a world scale, that is.

2. the average age of this group of SMM patients at the time of diagnosis was 64 (the range was 26 – 90). Now, while I have the utmost respect for the person or people who was/were 90 years old (at the time of diagnosis), I would have liked to have seen some data on the younger patients, for example the eight patients (3%) who were younger than 40. What has happened to them? Have they progressed to active myeloma? No such data is provided.

3. the risk of progression to myeloma, according to the Mayo study, is approximately 10% per year in the first five years…let me emphasize the adverb: APPROXIMATELY. That percentage goes down to APPROXIMATELY 3% per year in the next five years, then to APPROXIMATELY 1% per year after ten smoldering years. These percentages, therefore, should be taken for what they are: estimates…nothing more…

Now for my own conclusions. A sweeping statement similar to “most SMM patients will progress to MM within 15 years” and based on a sample of only 276 people is simply astounding. Unacceptable, in my view. Nobody, with the possible exception of Harry Potter, has the ability to predict that most of us, those taking curcumin, those taking resveratrol, those on the Gerson protocol, those laughing at comedies all day, those climbing mountains, etc. etc. etc., will progress some day to active myeloma…there are just too many variables involved (and I didn’t even mention DNA…!).

Back to the “Blood” study…Even though, I repeat, the three authors favour extremely aggressive myeloma treatments, they do point out that The clinician should therefore avoid treating asymptomatic and biochemically stable patients with active therapy, allowing current drug development efforts to mature to their maximal efficacy at a time when systemic treatment does become a necessity. Indeed, early intervention may only serve to identify those patients at early risk for progression, or worse, theoretically to select out more aggressive genetic subclones of myeloma.

Now, the underlined (by me, of course) bit is not the most comprehensible string of words ever written in the English language, but I think it means that early intervention might turn a not-so-aggressive type of myeloma into an aggressive type. This happened to a couple of friends of mine…and, in fact, it could easily have happened to me: when my former haematologist advised me to begin chemotherapy in the fall of 2005, I declined (based on a gut feeling) and sought the opinion of three well-known MM specialists who confirmed that I had done the right thing, that I was still in the “watch and wait, no CRAB symptoms” category. Let us never underestimate the importance of getting a second, even third (etc.), medical opinion…!

Sorry for going off on a tangent. From now on I will try to stick to the study. It’s just that I have strong opinions…in case you hadn’t noticed! 😉

The authors also say that smoldering patients should be carefully monitored. I couldn’t agree more. In fact, if I were a biologist and had a lab in my cellar, I would be monitoring my blood almost daily!

Which tests do they recommend for newly diagnosed myeloma patients? Well, in addition to the classical CRAB measurements of calcium, renal function, haemoglobin level, and skeletal survey, the Beta 2-microglobulin, albumin and lactate dehydrogenase (LDH) should be measured, as these latter tests impart prognostic significance. Investigations for the monoclonal protein (M) require both serum and urine (24 hour) samples and today could include the serum free light chain (sFLC) assay, which has become mandatory in non-secretory or oligosecretory MM and is often the first marker of response and progression. SFLC is also of value in solitary plasmacytoma, amyloidosis and in initial evaluation of MGUS to predict risk of progression to symptomatic MM.

They also recommend having a bone marrow biopsy to check for any abnormalities that would put the patient into a high-risk category.

And here is another important point: although the conventional skeletal survey remains the standard method for evaluation of bone lesions, magnetic resonance imaging (MRI) is more sensitive and is recommended to exclude spinal cord compression, soft tissue mass in a localized painful area or for assessing BM involvement in patients with solitary plasmacytoma and smouldering myeloma. The role of PET-CT is less well defined in MM, but can be useful for detecting extramedullary disease, unsuspected bone lesions and evaluating patients with plasmacytoma as well as non or oligo-secretory MM.

Quick aside (sorry, can’t help it!): after reading the vitamin D and myeloma study (see my Page on “Myeloma and vitamin D”), I am absolutely convinced that we should all have this simple test done on a routine basis…regardless of our stage (MGUS, SMM or MM). Please add it to your list.  

At any rate, these are the parts of the study dealing with asymptomatic (smoldering) myeloma. The rest focuses on ASCTs and on the authors’ personal predilection for aggressive treatments, via the use of multiple chemo drugs…especially with younger patients who are able to tolerate toxicities and pursue high dose therapy approaches. If my myeloma were to turn aggressive some day, I suppose I might consider such an approach. But for now my goal is to keep the tiger dormant…(see: http://tinyurl.com/yldk5y9).

P.S. Curiosity: since the authors of this study were more than one, shouldn’t the title have been “How we treat multiple myeloma in younger patients”? Hmmm…

Okay, the holidays are finally over…I have been giving my brain a bit of a rest but am now ready to start reading the studies that have been collecting dust on my desktop…

Today, though, since I have some translations to do, I only have enough time to post about a recently-published abstract that I just read, see: http://tinyurl.com/yaewa9q. Here we have the case of a 39-year-old man with IgG kappa myeloma (my type, incidentally) who failed two chemo treatments but responded to other chemo combos, had an autologous SCT (stem cell transplant), then a kidney transplant that, however, didn’t go very well…anyway, you can go read the whole story…the poor guy had a very difficult time of it…

But this is the part that I really wanted to highlight: His maintenance therapy, in addition to six 2-week-long cycles of bortezomib separated by 1-week rest periods, includes cyclosporine (50 mg twice daily), prednisone (10 mg daily), and curcumin (9 g daily).

Wait a sec…what was that again??? Let’s see…bortezomib, cyclosporine, prednisone and…er…curcumin??? I was absolutely stunned when I first read that sentence. Pleased, too, obviously. But mainly, stunned.

I mean, here we have curcumin being used as part of a conventional myeloma treatment…This is the first time, I think!, that I have read anything of the sort…I sincerely hope it’s not the last…oh, I really hope so…

A blog reader (thank you!) sent me a list of test blunders (real ones, apparently) that cracked me up this morning. Enjoy!

Q: What was Sir Walter Raleigh famous for? A: He is a noted figure in history because he invented cigarettes and started a craze for bicycles.

Q: What did Mahatma Gandhi and Genghis Khan have in common? A: Unusual names.

Q: Name one of the early Romans’ greatest achievements. A: Learning to speak Latin.

Q: Name one measure that can be put into place to avoid river flooding in times of excessive rainfall (e.g. in Mississippi ) A: Flooding in areas such as the Mississippi may be avoided by placing a number of dames into the river.

Q: Name six animals that live specifically in the Arctic. A: Two polar bears; three (crossed out), four seals

Q: Assess Fashion House plc’s choice to locate its factory near Birmingham. Is Birmingham the right location for this type of business? A: No. People from Birmingham aren’t very fashionable.

Q: How does Romeo’s character develop throughout the play? A: It doesn’t, it’s just self, self, self all the way through.

Q: Name the wife of Orpheus whom he attempted to save from the underworld. A: Mrs Orpheus

Q: Where was the American Declaration of Independence signed? A: At the bottom.

Q: What happens during puberty to a boy? A: He says goodbye to his childhood – enters adultery.

Q: State three drawbacks of hedgerow removal. A: 1. All the cows will escape. 2. The cars drive into the field. 3. There is nowhere to hide.

Q: What is the meaning of the word ‘varicose’? A: close by.

Q: What is a fibula? A: A little lie.

Q: Why would living close to a mobile phone mast cause ill health? A: You might walk into it.

Q: Joanna works in an office. Her computer is a stand-alone system. What is a stand-alone computer system? A: It doesn’t come with a chair.

Q: Steve is driving his car. He is travelling at 60 feet/second and the speed limit is 40 mph. Is Steve speeding? A: He could find out by checking his speedometer.

Q: Give a reason why people would want to live near power lines. A: You get your electricity faster.

Q: Where was Hadrian’s Wall built? A: Around Hadrian’s garden.

Q: The race of people known as Malays come from which country? A: Malaria

Q: What is a vibration? A: There are good vibrations and bad vibrations. Good vibrations were discovered in the 1960s.

On Saturday Stefano and I met my best friend (see previous post), his wife and 8-year-old daughter (cute as a button; she has officially adopted me as “aunt,” by the way…I am very proud and happy about that!) at San Galgano, a Cistercian abbey built in the 13^th century in the province of Siena, a 1.5 hour drive south of Florence. In the 18^th century, the bell tower fell onto the vaulted roof, which collapsed. The walls, however, are still standing…creating a sort of magical atmosphere inside this magnificent Gothic church. Here are a couple of the many photos I took (Stefano took almost 200 photos…!).

The abbey is now a tourist attraction as well as the setting for concerts and theatrical performances. I have never been to a concert at San Galgano and can only imagine how it must feel to sit inside the church in the evening, look up at the stars and listen to Gregorian chants…like being transported back in time…I really must have a look at the summer 2010 concert schedule!

We also visited the nearby chapel of Montesiepi, which preserves the sword that Saint Galgano allegedly thrust into a rock in 1180, intending to use it as a sort of altar (see photo). For years the sword was considered to be a fake, but recent tests have shown that it really does date to the 12^th century. Many, in fact, believe that the myth of King Arthur and his sword Excalibur originated right here in Tuscany! I have no opinion in the matter…but I thought the chapel was lovely and had great views of the surrounding countryside.

From San Galgano, we drove to Massa Marittima, about 20 kilometres from the Tyrrhenian Sea. It is a hilltop Medieval town of probable Etruscan origin. Its cathedral, built in the 13^th century, is a fine example of Romanesque-Gothic architecture. Instead of a photo of the cathedral, though, I decided to publish a photo of one of Massa Marittima’s narrow cobblestone alleys…if you look closely enough at this one, you will see a few large and colourful glass jars sitting on a sort of wooden “bridge” over the alley. Lovely…

Well, at any rate, if you happen to be in the area…that is, about 30 kilometres southwest of Siena…don’t forget to visit the abbey of San Galgano, the chapel of Montesiepi and the town of Massa Marittima. Well worth it!

The best part about these holidays:

1. being together (=Stefano and I) whenever we want, not just on weekends and weekday evenings. 
2. getting together (after several years of being apart) with my best friend from my University of Florence period and realizing that true friends are friends forever…I am so happy that we have found each other again!
3. forgetting about myeloma (that is, until I received my test results!).

Speaking of which, after my not-so-hot saw palmetto results (which could be a fluke since, due to busy times, I was a bit sloppy about scheduling my daily supplement intake…), I have decided to test ashwagandha again. In case you don’t remember: ashwagandha, also known as Indian ginseng, has strong anti-myeloma activity and has been used in traditional medicine forever. I tested it last fall (September 2009), and my October test results were excellent. I still have enough ashwagandha for another trial. We shall see!

Incidentally, I am not giving up on saw palmetto, since a few blog readers have told me privately about their good results with it…besides, could my good immunoglobulins have increased thanks to saw palmetto?

By the way, a good friend (who has copies of my test results) pointed out that my IgA hasn’t been this high in years. If my myeloma were taking off, he added, my good Igs would (probably!) go down, not up. I hadn’t considered it from that angle. Well, another thing to celebrate…!

I was searching the Internet for a nice Happy 2010 photo and found this one (above) on an Italian website. I like it because the sign is pointing in a bright and sunny direction…I will drink to that! Felice Anno Nuovo a tutti! Happy New Year, everyone!