I am in the middle of a huge translation (which is great, since we can certainly use the extra bit of money), so I don’t have much time to dedicate to my blog today. But I couldn’t help posting briefly about an amazing love story…I am sure it will touch your heart the way it touched mine…Even those of you who don’t care for cats. Yes, this is a feline love story. I read about it earlier today the Italian National Agency for Animal Protection (ENPA)’s Facebook page…

Here is the story, which I have translated (loosely) from the ENPA article, which you can read here: http://goo.gl/tauqk By the way, I am a bit tired right now from having translated a large legal document, so please forgive any weird stuff that doesn’t make any sense… 🙂

Ginevra and Lancillotto were two inseparable stray cats living in a cat colony in the city of Genoa, Italy. One day, Anna, one of the human volunteers who provides food to this particular colony, noticed that Ginevra had lost a lot of weight and looked ill. She immediately took Ginevra off to an ENPA vet clinic on the other side of the city. Anna knew that Ginevra and Lancillotto were very close but had to leave him behind. He was perfectly healthy…no reason to take him to the clinic, too…

Three weeks passed. Ginevra was slowly on the way to making a full recovery. But one thing was clear: she wouldn’t be able to go back to her previous, stray-kitty life. She needed to be adopted.

Well, at one point, another volunteer, Elisa, began noticing an orange tabby sitting in front of the clinic where Ginevra was still convalescing. A big cat staring fixedly at the door of the clinic. She thought the cat might be hungry, but no, he refused all the food she brought out for him. Finally, thinking that this orange cat had been abandoned, she consulted Anna, who went outside and recognized Lancillotto. She opened the door of the clinic. Immediately, Ginevra ran outside into the clinic’s yard, where she and Lancillotto were finally reunited…They began happily purring, butting heads and rubbing against each other…

To find his beloved Ginevra, Lancillotto had travelled to the other side of the city…walking for more than four kilometers…facing who knows how many dangers…traffic, etc… What I can’t get over is this: how did he know where to go? Amazing…absolutely amazing…

Ginevra and Lancillotto’s story doesn’t end here. Unfortunately, it is harder to find a home for two kitties than for one. So the volunteers were at a loss. They didn’t want to separate the two friends again, but Ginevra really needed to be adopted by a loving family. What to do with Lancillotto?

Well, I am happy, very happy, to report that a kind-hearted man heard this story and adopted both cats…so they are together now…

Here you can see a photo of the two kitties in their new home: http://goo.gl/hxzgT 

A blogging friend just lost her much beloved husband to myeloma…ah, here come the tears again…Well, this may sound very odd to you, and in fact it sounds quite odd to me, too, as I write these final words, but I wish to dedicate this unusual but heartwarming love story to them…

Sad days for the myeloma family, these…

And now, finally, we get to the Conclusion. The researchers state that, from a clinical standpoint, it is essential to identify which of us are going to progress to MM, in order for our doctors to be able to keep a closer eye on those in a high-risk category and be able to use some or all of these markers to determine the choice of therapy and response to therapy in patients with full-blown MM.

From a research standpoint, they say, the development of better biologic and molecular markers will improve our understanding of the molecular pathways involved in disease progression in patients with MGUS/MM. This, in turn, will help identify newer therapeutic targets and novel treatments…

More or less, that is the study’s conclusion. But I still have a few comments to make on what I read in the middle of the study…at the end of the discussion concerning genetic abnormalities, hyperdiploidy, trisomies, RAS mutations and MYC up-regulations:

Taken together, although many of the above-mentioned markers have been identified in patients with MGUS, and the prevalence of some markers has been reported to differ between MGUS and MM, currently it is unknown whether any markers are associated with an excess risk of progressing from MGUS to MM. Importantly, at this time no systematic study using serial samples (from the same patient over time) has been conducted to formally address the role of these genetic markers in predicting disease progression in patients with MGUS/SMM.

What this section says to me…quite loudly, in fact…is that all the MGUS/SMM progression studies are little more than a long series of words and sentences surrounded by elaborate graphs and Tables. To be blunt, these studies are essentially useless to us (=the patients). The bottom line, in fact,  is that not even one of them can predict who will progress to active myeloma and who will remain at the MGUS or SMM stages…

At this point, though, I asked myself the following question: do I really need or even want to know if I am going to progress to active myeloma some day? Heck. No. I. Definitely. Do. Not.

Knowing what might or might not lie ahead for me two, four or ten years from now wouldn’t have an impact on my life… Oh wait a second. That is not entirely true. It would almost certainly have an impact: stress, to some degree. And stress, as we know, makes MM cells proliferate (http://margaret.healthblogs.org/life-with-myeloma/what-is-multiple-myeloma/multiple-myeloma-and-stress/).

So why would I willingly choose to add a “timer” to my daily life? Indeed, why would I choose to add to Stefano’s burden of worry and stress (…even though he never shows it, I know it’s there…)? Or to my family’s worries? Why? Why? Why? Wouldn’t it be better just to enjoy my life, husband and cats, have fun with my friends, take curcumin and other promising anti-myeloma, non-toxic, backed-by-science substances and so on?

Sometimes, just sometimes, perhaps it is best not to know: “Where ignorance is bliss, ‘tis folly to be wise…”

Now, don’t get me wrong, eh. Blissful ignorance doesn’t mean that I never think about the possibility that one day I might progress to full-blown myeloma. Hah. Believe me, I do…perhaps not every single day…but I do… And, when I find out that a myeloma friend, especially one close to my heart, is dying, the emotional pain is a bit hard to bear…Susie, many hugs to you…

No, blissful ignorance doesn’t mean that I will stop doing all the things I do to slow down or even, wowsie!, halt my progression… Besides, all of these activities really help me deal with my fear of (and anger toward!) the nasty beastie that is currently slumbering inside my bone marrow…

And my research and ramblings might be of help to others, too. That is a great comfort to me…

Yes yes yes, I am indeed procrastinating on my “possible viral connection” piece, which has turned into a daunting magnus opus…But at least I am procrastinating with a study that will, I hope, provide us with some juicy food for thought and, why not?, a bit of constructive debate. I have divided my long post into two parts…and will be posting Part II after I get home from work tomorrow…

A blog reader/Facebook friend (thanks!) notified me about a new progression-from-MGUS-to-MM study, which I asked another friend (more thanks!) to retrieve for me. Click here to read the abstract: http://goo.gl/MWpRY A key excerpt: …it currently is not possible to accurately determine individual risk of progression. Well, in addition, sigh, to containing a split infinitive that makes my skin crawl, that statement doesn’t really sound too promising, does it? Well, let’s have a look at the full study now…

In the Introduction we find a discussion of “racial disparity patterns.” MGUS and MM are 2-3 times more common in African-Americans than in Caucasians, and Asians have a lower prevalence of MGUS than Caucasians. Why is that, I wondered? Diet? Genetic makeup? Luck? What?

And there is also a certain degree of familial clustering…that is, if someone in your family has MM, then you apparently have a higher risk, perhaps two-fold, of developing it. The researchers therefore conclude that there seem to be susceptibility genes in the causation of MGUS and MM. No cases of multiple myeloma in my own family, incidentally. I am the first…and, I hope, the last!

Ah, here is an interesting bit of news: Although MGUS is commonly referred to as a single entity in the literature, indeed there are two kinds of MGUS: lymphoid (or lymphoplasmacytoid) MGUS, and plasma cell MGUS. Let’s take a closer look:

1. Between 15 and 20% of MGUS folks belong to the former group: they secrete IgM and can progress to Waldenström macroglobulinemia, lymphoma, or other malignant lymphoproliferative disorders.

2. Most MGUS folks instead have a plasma cell phenotype, characterized by a serum M-protein concentration of less than 3 g/dL, fewer than 10% of plasma cells in the bone marrow, and with no end organ damage.

The two types of MGUS are completely different, on a biological level. This study focuses on the second group…

Reading on and skipping a few bits. Ah, here we go. The authors discuss the two major models for risk stratification: 1. the Mayo Clinic model and 2. the Spanish study model. Concerning the latter, do you remember the fuming post I wrote about the SMM “high-risk” Spanish study? Ooooh, whenever I am reminded of that study, my blood begins boiling…For a reminder, see: http://margaret.healthblogs.org/life-with-myeloma/what-is-multiple-myeloma/myeloma-supplements-and-il-1-beta/a-high-risk-smoldering-myeloma-study-ridikkulous/. Oh well…

Let’s look first at the Mayo Clinic model, which focuses on serum protein abnormalities. The following features are considered as adverse risk factors: non-IgG isotype, M-protein concentration 41.5 g/dL, and an abnormal serum free light chain (FLC) ratio (normal reference 0.26–1.65). In the Mayo Clinic model, at 20 years of follow-up, patients with MGUS with all three risk factors on average have an absolute risk of MM progression of 58%; for MGUS patients with two, one, and none of these risk factors, the corresponding absolute risk is 37%, 21%, and 5%, respectively.

This model also gives SMM risk factors: serum M-protein concentration >3 g/dL, bone marrow plasma cells >10%, and an abnormal free light chain ratio. The cumulative risk of progression at 10 years with one, two, and three of the risk factors was 50%, 65%, and 84%, respectively. Based on this model, by the way, I am in the group with an 84% risk of progression. Well, no surprise. I can interpret my own numbers by now. So far, they haven’t scared me… Besides, statistics are just…numbers… 

I would really really really like to skip the Spanish SMM study altogether, for the above-mentioned reasons…but no, I won’t. For the sake of fairness. The Spanish model uses BMBs (=bone marrow biopsies) to determine the ratio of phenotypically aberrant plasma cells (aPCs) to total bone marrow plasma cells (BMPCs) at diagnosis. The patients with at least 95% aPCs/BMPCs at diagnosis had a significantly higher risk of MM progression. Other factors, such as immunoparesis (=the reduction of one or two immunoglobulins, in a nutshell) and DNA aneuploidy (=DNA abnormalities, again, in a nutshell), are also considered.

More specifically, for patients with MGUS with no, one, or two risk factors (>95% aPCs/BMPCs and DNA aneuploidy), the risk of progression at 5 years was 2%, 10%, and 46%, respectively. For patients with SMM (risk factors: >95% aPCs/ BMPCs and immunoparesis), the corresponding numbers were 4%, 46%, and 72%, respectively. Okay, I think I have devoted enough attention to the Spanish model…

Our study authors reach the conclusion that the risk of MM progression varies greatly among individuals diagnosed with MM precursor disease. Clearly, we need better markers to define high-risk (versus low-risk) MGUS/SMM and to better predict individual risk of MM progression.

Subsequent sections deal with:

1. MicroRNAs. Remember my miRNA post (=October 28)? If not, here is the link: http://margaret.healthblogs.org/?s=microRNA At any rate, the study authors tell us that It is now known that miRNAs can act as tumor suppressors or proto-oncogenes, and that they are misregulated in most human cancers. So these thingies could perhaps be used as markers of malignant disease in a wide variety of cancers. I will skip the technical bits, i.e., the detailed descriptions of miR-93 versus miR-106b…uff uff uff. Bottom line: some miRNAs were up-regulated in MM but not in MGUS…

2. Gene promoter methylation. Oh no, no way…not getting into that…skipskipskip…

3. Molecular imaging. Yes, let’s have a quick look at this topic. Here we learn that in the future it may be easier to detect bone lesions using molecular imaging techniques equipped with novel MM-specific tracers. That sounds helpful. In particular, they discuss the use of a Fluorodeoxyglucose (FDG)-PET/CT, which can detect bone marrow/myelomatous involvement with a quite high sensitivity and specificity. The radiation exposure, we are told, is about 1.6 REM.

I looked up the amount of radiation that we get from a chest X-ray = 0.01 REM…So 1.6 sounds like quite a bit…! The authors tell us that, as far as they know, this new technology hasn’t been used to identify early skeletal lesions in patients with MGUS…Too much radiation, I wonder?

They then discuss the “angiogenic switch” hypothesis, which is an attempt to explain the progression from a pre-malignant to a malignant stage. This switch would result from cumulative genetic damage leading to an imbalance of pro- and anti-angiogenic factors, creating an adequate microenvironment for a tumor to grow. I don’t want to go over the process of angiogenesis again, since I have written quite a lot about it here…

An important excerpt: In MM, increased angiogenesis results in changes of microcirculation in bone marrow. Interestingly, MGUS patients have a low-intensity pattern of microcirculation compared to MM patients. But, the researchers add, more studies are needed in order to determine whether a particular type of contrast-enhanced MRI, called DCE-MRI, can be used to predict progression to MM…

Wait a second. Contrast liquid? Could it be gadolinium? I checked on PubMed, and yes, gadolinium is indeed used in these types of MRIs… Do you remember my post on gadolinium, by any chance? If not, see: http://margaret.healthblogs.org/life-with-myeloma/what-is-multiple-myeloma/mris-and-gadolinium/ Incidentally, the reason WHY I began wondering about gadolinium is when I read that a patient with MGUS/SMM with a pathologic DCE-MRI pattern developed a progression to MM 6 months after the DCE-MRI. Hmmm and double-hmmm. Progressing to active myeloma just six months after having a DCE-MRI… Fate or pure coincidence? Or…something else?

Nope, I don’t think that I would ever have one of those MRIs…

This morning I read and wrote a draft, which I still need to finish editing, about an interesting, recent study on MGUS and SMM progression to MM. Well, I used the “tinyurl” function to shorten my links’ terribly long URLs…as I have always done. At one point, though, to my horror, I realized that the tinyurls weren’t working. Not working? Holy cats! I immediately checked some older tinyurls, and they didn’t work, either. 😯 AAAGGGHHH! Well, of course, it would be absolutely IMPOSSIBLE for me to check every single tinyurl that I have used in my 860 plus posts…ah no, no way I’m going to do that. Indeed, no way I can do that! 

This is what I have done: I have changed a few of the most recent ones and will continue to do so from time to time (“time” being the key word, here!). One thing is for sure: I will never use this function again. Ever.

Last but not least: if you wish to check out a link that I have published here but are unable to do so for the above-mentioned reason, please let me know, and I will do my best to retrieve the reference/link for you. I hope, fingers crossed, that it is just a temporary “tinyurl” glitch, but I won’t be taking any chances from now on…Okay, enough said, I have to eat lunch now, then finish editing my post…

P.S. Ah, mystery solved: the tinyurl website is down. Well, I am still not reassured or pleased that this occurred and will probably use full links from now on…whenever possible.

This afternoon I am getting together with my girlfriends…playing cards…laughing…Yay! So I have no time to do any reading/research…

So, since today I am in my “fun fun fun” mode, I wanted to post the link to a video that a blog reader/myeloma friend put on her Facebook page today: http://www.youtube.com/watch?v=9vIfNn4pgw8 Awwww!

It’s one of the cutest kitty videos that I have seen since “Surprised Kitty” http://www.youtube.com/watch?v=0Bmhjf0rKe8. Oh, and let’s not forget “Kitten Surprise!” http://www.youtube.com/watch?v=YLDbGqJ2KYk And how about the two kitties on a treadmill? http://www.youtube.com/watch?v=yVjzd320gew Okay, I have to stop here…Have a great day, everyone! Ciaoooo!

Xmas is right around the corner, and there are so many worthwhile causes/projects that could really use our support. Well, it just so happens that I have a couple of excellent suggestions for your Xmas shopping: the Honeybeaders’ bracelets and the Myeloma buddies…

THE HONEYBEADERS. This fundraising project was started by a small group of family and friends of Scott, a myeloma friend of mine. All the money they raise goes to support multiple myeloma research…and by that I mean a REAL, specific research project. 

This project, as we can read on the Honeybeader website (link provided below), is being carried out right now at the Roswell Park Cancer Institute, and, if all goes as expected/hoped, should yield some very interesting (non toxic!) results…so I am very very VERY excited about it…

Anyway, with their deft little hands, the fabulous Honeybeaders create lovely Cancer Awareness bracelets for all types of cancer, not just myeloma. I happen to be the proud wearer of three bracelets, in fact (see photos). Oh, and as you can see by Peekaboo’s reaction, these bracelets can also double as cat entertainment toys, with careful human supervision… 🙂

Last year I gave myeloma bracelets to my mother, sister, niece and girlfriends…And they were so admired by other friends, in fact, that I just put in a Xmas order, too…

You can have a look at the Honeybeader website and place your order/s here: http://thehoneybeaders.com/

MYELOMA BUDDIES. This is my creative friend Paula’s project to raise funds for Myeloma UK and the International Myeloma Foundation. Again, I can tell you firsthand that her dolls are adorable…irresistible, in fact.

This photo shows a rather grumpy Piccolo (I woke him up to take this photo…) posing with one of Paula’s multi-colored buddies, which are a bit larger than regular buddies…

Word of caution: don’t leave your buddy unattended with your pets…My youngest kitty, Pinga the Terrible, almost made off with one, right under my nose…

I took my own purse-sized Myeloma buddy (see photos below) to Rome with us a few weeks ago. While we were in the car, driving to Rome, I asked Stefano to help me find a name for her. He came up with “Honey,” because, he said, honey is “miele” in Italian, and myeloma is “mieloma.” So honey = miele = mieloma = myeloma. Get it? Hmmm, made sense to me. 😉

So her name is Honey.

The last three photos I posted here are of Honey visiting the Colosseum (the inside) and Emperor Hadrian’s villa…Speaking of which, I have an amusing little story (amusing to me, at any rate!). First, you should know that I was strolling around Hadrian’s villa, admiring these lovely, majestic ruins, with my little Honey nestled in my scarf. Passing tourists looked at me most peculiarly upon noticing her…but of course I didn’t care one whit…

I’m a happy, free spirit…

Anyway, at one point I happened upon an obviously bored little Italian girl who was really hacking away at one of the villa’s columns, chipping off bits and so on. She was about 8 years old…old enough, that is, to know better.

Since her parents had gone off to admire the view and were completely ignoring her (!), I gently but firmly reprimanded her…in Italian, of course. She gave me the oddest look, said nothing and continued to chip away at the column… I gave up. As I walked away, defeated, I realized that, with a doll sticking out of my scarf, I probably looked anything BUT a figure of authority…

No wonder she paid no heed to me…! Hehe.

Okay, enough babbling…Let’s get to the point. Check out Paula’s myeloma buddies for yourselves: http://www.etsy.com/listing/45335069/handknit-myeloma-buddy-charity-doll And don’t forget to have a look at her blog and at her super cute and brand new Xmas buddies! 

Oh, and in case this were not obvious, these buddies are NOT JUST FOR CHILDREN, since I have given buddies to my mother, sister, niece, AND I will be giving some to my girlfriends for Xmas…huge success so far.

Everyone needs a myeloma buddy and a myeloma beaded bracelet! EVERYONE!!!

Besides, this is Xmas shopping made easy…easy peasy, in fact! All you need to do is check out these two websites and place your orders. I already have. 🙂

At lunchtime, two of my cats broke a dish (long story; I will spare you), which shattered into about a million and a half pieces that flew everywhere, even under (!) a rug. So this seemed like the purrfect time to post the link to the most recent “Simon’s Cat” video: http://www.youtube.com/watch?v=vv0OUdQNVM0

I dedicate this post to Bob O. (even though you were more of a dog person than a cat person!)…

I stopped working for a while on the possible viral connection to myeloma (nope, I haven’t forgotten all your messages and contacts–it’s just that it is going to take some time to finish reading and attempting to understand all the studies and notes…I now have accumulated an overwhelming amount of material, which I am going through alone…so please please be patient… 🙂 ) to have a look at a brand new study published in “Blood”…one that sounds quite promising. It concerns an anti-myeloma “dendritic/tumor cell fusion” vaccine that has been tested in a Phase I study on myeloma patients…

When I first read the abstract, I was intrigued enough to ask a kind friend (thanks!) to retrieve the full study for me. Here is the abstract: http://bloodjournal.hematologylibrary.org/cgi/content/short/blood-2010-04-277137v1

As we can read, this was a phase I study in which patients with multiple myeloma (MM) underwent serial vaccination with the DC/MM fusions in conjunction with GM-CSF. Uhm, whaaat? Okay, con calma, as we say in Italian: 1. GM-CSF stands for Granulocyte-Macrophage Colony Stimulating Factor and is basically a substance (a cytokine) that stimulates the production of white cells; 2. DCs are dendritic cells, which are the main guardians of our immune system. Whenever our bodies are attacked by viruses or bacteria, the dendritic cells are the first to alert all the other immune cells of the danger. In cancer patients, though, DCs are defective…not surprisingly…hah.

Anyway, the study states that the anti-myeloma vaccine worked (more or less, as we will see) for 17 out of 18 myeloma patients, most of whom remained stable for varying periods—between 2.5 months and 41 months. 41 months is almost three and a half years. Not bad. Hmmm, but wait a sec, what about patient number 18? The full study solves the mystery: he/she was excluded from the study because of inadequate cell yields for vaccine generation. Ah, okay.

The vaccine was well tolerated without evidence of dose limiting toxicity. This is also very good news. The full study provides more details (see below…).

Okay, let’s go. The full study begins with a brief mention of the various therapeutic options offered to myeloma patients, pointing out that none are curative, not even autologous stem cell transplants, due to the eventual emergence of resistant disease. In contrast, the researchers add, the unique efficacy of cellular immunotherapy is supported by the observation that allogeneic hematopoietic stem cell transplantation is curative for a subset of patients due to the graft versus disease effect mediated by alloreactive lymphocytes. The problem with allo transplants, as we well know, is that only a tiny percentage of patients survive them…Well, this has little to do with the point of this post, so let’s proceed…

One important point: donor-derived cells (i.e., those used in allogeneic stem cell transplants) don’t specifically target myeloma cells, which, in addition to the regimen related toxicity, give rise to GVHD, or graft versus host disease. So this group of researchers looked at developing a “specific” vaccine that would stimulate the immune system to eliminate malignant cells and eradicate residual disease persisting following biologic therapy and autologous stem cell transplantation. And they developed a selective, autologous dendritic/tumor cell fusion myeloma vaccine…

Skip skip skip…overly technical bits. Ah, here we get to an interesting part…What type of patients participated in this Phase I study? A total of 18 patients, 12 men and 6 women, average age: 57, were found eligible. Most of them had active myeloma and had received at least 1 prior treatment regimen. 14 patients had previously gone through high-dose chemo and autologous SCTs…

Oh holy cats,! I almost fell off my chair when I read the subsequent sentence: In addition, patients with stage 1 myeloma who did not require therapy and were otherwise being observed were eligible. STAGE ONE MYELOMA PATIENTS???!!! This is such a vital bit of information! As you can imagine, my interest was piqued…went sky high, in fact…

Moving on: Patients must exhibit at least 20% involvement of the bone marrow with myeloma cells to facilitate vaccine generation. Patients must not have been treated with chemotherapy, steroids, radiation therapy, or immunotherapy within 4 weeks of study enrollment. Patients with a history of clinically significant autoimmune disease or organ dysfunction as measured by a bilirubin > 2.0 or creatinine > 2.0 were excluded. During the study, a patient developed a heart problem (unrelated to the therapy, though) and was excluded…

The researchers compared the patients’ post-vaccination CD4+ and CD8+ T cells to their pre-vaccination levels. Of 15 evaluable patients, 11 patients demonstrated at least a 2 fold increase in the percentage of CD4 and/or CD8+ tumor reactive T cells. That means that in 11 patients, the vaccine was able to stimulate the immune system…in a specific manner…

The vaccine was also well tolerated, as we already knew from the abstract. A few more details: at the most, there were a few grade II events (listed in a Table at the end of the study), but nothing major, from what I could tell. Oh wait, there was one, possibly related, pulmonary embolus (Grade 4), though in the Discussion part the researchers note that this particular patient had a prior history of DVTs. Most of the reactions were at the “injection site” = itching and redness. There were also a few instances of fatigue, diarrhea, etc., but nothing that really stands out to me, apart from that Grade 4 case., which might not be related… 

Another important point is that vaccination did not result in signs of autoimmunity or suppression of blood counts, meaning that the vaccine didn’t have any bad effects on the patients’ red and white cell counts. Good.

So what happened to these patients in the long run? Of 16 evaluable patients, 11 patients demonstrated stable disease following vaccination. Three patients have ongoing stable disease following vaccination without evidence of progression at 12, 25, and 41 months. An additional 8 patients exhibited disease stabilization for 2.5 (4 patients) 3, 4, 4.5, and 5 months following vaccination. This sentence, and the use of the past tense “exhibited,” implies that the myeloma of eight patients did progress after 2.5, 3, 4, 4.5 and 5 months…Phooey, that titbit puts a bit of a dampener on things, doesn’t it? Three patients out of eleven…That is less than 30%…Oh well. And there is also no more talk of disease “eradication,” only “stabilization,” which is another dampener…

Well, let’s proceed to the Discussion part of the study: an interesting thing about this vaccine is that it is autologous and tumor-SPECIFIC. The vaccine, that is, was composed of a mixture of the patients’ myeloma and dendritic cells, with a few other things thrown in, such as GM-CSF…

Here the researchers surmise that patients in less advanced stages of myeloma might have a longer-term response compared to those in a more advanced stage of myeloma. And, in fact, they point out that it is not easy to interpret the study results because of the differences between the myeloma patients enrolled, most of whom had advanced and heavily pre-treated myeloma…

But hey, let’s not forget about those two patients in Stage 1. I went through the study carefully (or so I think!), looking for more information on them but found nothing. I wonder if they were the ones who had the most positive reactions to the vaccine…the ones that remained stable at 25 and 41 months? It makes sense, but I have no proof of that, just a hunch that might actually turn out to be more than a hunch, since the researchers note that patients with a lower disease state might fare better than those with bulky disease…In my view, if that were the case, the position of the vaccine would be weakened. However, if that were not the case, said position would be strengthened. I mean, it is one thing if the anti-myeloma vaccine kept a Stage 1 patient stable (the patient might have remained stable anyway), quite another if the patient were in an advanced stage of myeloma…Well, this is pure speculation on my part, of course.  

Obviously, more studies are needed…and more patients need to be recruited, especially those in early stages of myeloma and/or, as the researchers themselves indicate, those who have recently undergone autologous SCTs…

I have to admit that I teared up a bit as I read through the Discussion. I mean, just think about it: at some point in the future the cure for myeloma might be a simple vaccination or a series of vaccinations. Wouldn’t that be fabbbulous? But the fact that the vaccine worked well only in three (our of eleven) cases makes me think that we are still quite far from that goal…

However, in spite of all the dampeners that I have mentioned, I am feeling optimistic and look forward to reading more on this topic…

Yesterday morning I woke up with one of those awful “drilling-a-hole-through-your-head” types of headache. No big deal. I got up and went downstairs to feed the cats and make my usual cup of cappuccino. After tending to my kitties, though, I began sweating buckets and feeling quite nauseous, so I figured coffee might not be a good idea after all and went back to bed. To make things short, I threw up twice and then spent the entire day in bed, sleeping and alternating between chills and sweats. In spite of having piles of blankets on top of me and being surrounded by my warm and very attentive cats, I felt very cold most of the time. I also had no appetite at all–I ate only a few crackers at dinnertime. But no, I didn’t have any fever…

Today I feel a bit weak but otherwise okay. My appetite is back, and I have done a bit of cooking, cleaned the kitchen, changed one of the cat boxes and so on…So tomorrow I am definitely going back to work. But I have been wondering: what could it have been? The onset of menopause? A virus giving me some sort of warning signal? Or something I caught from one of my students, who came to work on Tuesday with a high fever (aaaagh!!!)?

No idea. Odd, very odd…but anyway, it’s over, and that is what matters…!

Off and on, I have kept in touch with a couple of Nancy “La Cootina”‘s Hoodie friends. Nancy had “introduced” us via e-mail some time before she went into hospice. These friends, whom I shall refer to as K and MA, are the ones who informed me that Nancy had died, in fact (http://margaret.healthblogs.org/2010/05/04/well-the-news-is-out/).

Well, this morning I received a lovely lovely lovely message from K. Since I am 100% positive that other myeloma bloggers/Internet friends would like to read this update, too, I obtained permission to post some relevant parts:

“On numerous occasions, during the summer/fall of 2009, when MA and I would return to […], after taking Nancy’s little dog Molly for a hike in the woods, Nancy would tell us that she wanted to have a dinner to thank her “hoodie” friends. At about that same time period, as we all now know, her conventional cancer protocol was proving to be ineffective.  As a result, Nancy simply ran out of time and the strength it would take to plan and host a dinner for perhaps a dozen or more neighbors.
So, we lost our dear friend before we could gather again for a dinner at her house. Instead, her house stood empty when the hoodies gathered for a hoodie meal at X*’s house after we all launched our candles in honor of our departed friend, “Crankypants.”
About when Nancy’s home was sold, her brother, Marty, let us know that Nancy had left some money for a “Hoodie” Dinner. We planned a meal much like Nancy would have served. (Salmon, green beans, salad, oriental rice, rolls, fruit pies and wines.) We hired a caterer, sent out invitations and got X’s dining room ready.
Last night fourteen hoodies, Nancy’s mom, dad, sister and two nieces squeezed around one long table for Nancy’s “Hoodie” Dinner. Also present were canine friends Molly, Gracie and Harp.
It was noisy, it was fun and there were some tears but I’m sure most of us were happy that we had been touched, once again, by Nancy’s thoughtfulness.”

(*X is another Hoodie.)

Note: Nancy’s beloved dog, Molly, was adopted by K and MA and their other dogs and cats when Nancy’s health began declining. And I am happy to report that Molly is doing just fine now.

One last thing: I would like to thank K and MA publicly for keeping in touch with me and for having sent me a whole bunch of wonderful photos…photos of Molly…of the candle ceremony last year…and of this recent dinner in Nancy’s honor.

Ah, drat, there go the tears, again…