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A Reason For Hope

It’s been a pretty crazy last couple of months in my myeloma world. My March labs were a bit iffy. Things looked pretty good, but I still had a hint of myeloma showing up. We were going to do a bone marrow biopsy, but that never happened due to something on the doctor’s end.

I went into April’s labs expecting more of the same, crossing my fingers for zeros. Most of my labs came back in the normal time frame, light chains still normal or low. My immunofixation electrophoresis (which is a myeloma blood test) didn’t come back in the normal time frame.

“What’s going on?” I asked myself. “Where are the results?”

The days went by, and they didn’t result. Finally, half of it resulted late in the week, and it showed a reading of my m-band of .2. Previously I was at zero, so this was not good.

The second part of the test came back that afternoon, and I didn’t think it was going to show anything new, so I casually opened it and looked at it.

“Positive for IGM Kappa”.

“WHAT?!?”

My version of myeloma is IGG Lambda. Why is it showing IGM Kappa?

Did the labs mix up my blood with someone else’s blood? I read the notes from the lab, and it says they ran the blood twice from two different vials to double check due to my igg lambda history. It was correct.

A quick search, and I found out it is possible to have double light chain myeloma. It’s like having myeloma twice. It’s very rare, and in only 1% of people with myeloma.

“Face-slap”

What did I do?

After a few moments, I turned on some snappy music and started to dance.

Can I dance?

No

This is really bad news. Why am I dancing?

Because at this point, I said, “Seriously f*** you cancer.” “If you are going to be so bent on killing me, we are going to do things my way. I won’t let you drag me down. I’m going to keep living until I’m not.”

That’s why I’m dancing.

Normally, I look at my labs with my wife, but I didn’t think it was going to be anything, so she wasn’t there when I opened it. I had to tell her the news. It was like placing a 500 pound sack on her shoulders. Being the loved one of someone who has cancer has to be one of the hardest things in the world to endure. I think most people don’t realize this, and it is greatly underacknowledged what they go through. It’s not the same as having cancer, but I think it’s up there on the toughness scale.

I expected a phone call from my doctor, but it never came.

I just kept living my life as much as like normal as I could for the next month. Another round of ivig came the next month, and another round of blood tests.

The timing of the return of the tests was similar. Light chains came first.

Light Chains – Low / Ratio – normal

I had to wait another day and a half until my protein electrophoresis came back. My wife and I nervously opened the first one. How much had things progressed in a month, I wondered?

M-band – zero

“Wow”, we said.

We held our breath on the second part of the result as we opened it since this was the one that showed IGM Kappa (or IGG Lambda).

Normal – no trace of IGM IGA IGG kappa or lambda.

My wife and I looked at each other speechless. We weren’t quite sure what to say. One, because of my previous month’s crappy labs, and second, for this being the first time in 6 years that I’ve had a normal result.

I had a meeting with my myeloma specialist a few days later. Zoom kicked on and the doctor first thing looks at me and says “you know, Jothi, I’ve never met anyone like you.”

“Umm thanks?”

He went on to talk about the IGM kappa showing up.

“I called up the lab director to make sure there was no mistake.”

“It’s unheard of someone developing a second mutation from a car-t. Maybe the cancer mutated with it’s dying breath.”

“It’s uncommon for a person to zero out this far out from a car-t.” (I was at 9.5 months post car-t)

“It’s also unheard of, a month later, the new cancer mutation being wiped out. There is no trace of myeloma in your blood. I’ve never seen this before, and I have no explanation.”

A few months ago, they were talking about putting me on treatment again. They wanted a bone marrow biopsy first, which never happened. The doctor is now throwing around the “C” word (cured), which I’ve personally never heard one say before. I’m left asking myself if something special just happened?

Now being a statical anomaly, I’m left wondering why with no answers. Did my car-t strategy of supporting my t-cells have an effect?

It’s too early to tell anything, and I know full well things can flip back the other way around quickly. I try not to get too low when bad things happen, the same goes for trying not to get too high when things go right. I still need a bone marrow biopsy to check things out on a cellular level. Without that being zero, this could be just a blip in the road. Even if it is zero, I need to be zero and maintain that for a few years before I can relax and let some breath out. Cancer is just that unpredictable and volatile.

My point with this post is not to toot my own horn or have people congratulate me. I’ve been playing the cancer game for a number of years now. I’ve been around a lot of people challenged by cancer, and I know firsthand how dire things can be at times and frankly have periods of hopelessness.

Obviously, I’m thrilled with the ways things have gone in the past month personally. I would be equally thrilled if my tale could lift someone else up and give them a reason for hope. That unexpected things can and do happen if you just keep dancing.

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Oh Yeah, That’s What It Feels Like

That’s what I’m starting to say to myself.

It’s been awhile since I’ve felt like writing anything. I’ll have to try and remember what’s been going on, post CAR-T, in the last month or so.

I had my second infusion of antibodies and another round of myeloma blood tests. All my light chains were still about zero, below normal. My M-band is still hanging around with a reading of .5. That means that I still have cancer cells circulating in my blood. The doctor said since my light chains are basically zero, they expect my m-band to continue and drop, and hopefully disappear completely.

I have another round of blood tests this week. I’m very curious what my blood will say. I was scheduled to have a bone marrow biopsy a month ago. I was telling my doctor I didn’t see the point, since my blood was saying there was myeloma still circulating. Of course I was going to have a myeloma reading from my marrow. The thing I’m going for is MRD zero, which is no trace of myeloma in my marrow. So I got them to postpone the test.

I did end up having a few minor neurotoxicities, which turned my mind a bit sluggish. The extreme fatigue was a challenge, but I seem to be over both. I was on the antibiotic bactrim after my hospital stay, but it was dropping my platelets and red blood cells too much. Doctors are concerned with pneumonia post Car-t, so it was precautionary. They switched me over to another antibiotic, atovaquone, which is a liquid (?) type. It was basically like eating a sweet, good quality yellow paint. Gloppy, thick, and gross.

I ended up having an abnormal reaction to that stuff. It caused my inflammation to rise significantly, and it felt like I had thriving active myeloma again in my bones. It was painful, and I certainly didn’t want to feel like I had lots of cancer having a party inside of me after doing Car-t. I couldn’t help wondering if the treatment had bombed, because it sure felt like it. So it was a good mental struggle and stress, and was another hurdle to overcome. My last blood test said the opposite, so that took my load off.

So in the meantime of not doing anything medically related, I’m finding my body restarting its systems. Recently, I find myself saying “Oh yeah, that’s what it feels like to be normal”. I have energy again. My mind is sharp again. I’m not tired after doing a simple task. I’m not combating a steady dose of side effects from chemo. It’s funny what a person gets used to and becomes their version of “normal”.

I’ve been off chemo a few times in my myeloma marathon. I got Covid around 3 years ago, and the doctor stopped my Revlimid while I was dealing with that. I had a blood test before I was going to restart, and it showed the revlimid actually wasn’t doing anything. I decided to stop all chemo for about 8 months and try some alternatives.

The difference between then and now is that I knew the myeloma was increasing (very slowly) and contained somewhat, but I was getting worse over time. Now again, I’m off chemo, but it feels like the reverse is happening. I seem to be getting better over time.

So far, that makes me a big fan of Car-T. I’m still waiting and hoping the cancer zeroes out, and I don’t have to deal with myeloma. What kind of story will my blood write for me?

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Not A Typical Patient

Well, I’m going to attempt to just write something quick, I’m not sure if I’ll succeed. I’ve had more blood tests done and more doctor’s office visits. We ran some myeloma lab’s recently to start to check on the results of our efforts.

My light chains have practically disappeared. Everyone is supposed to be in normal range for normal blood formation. I’m now low on both. Just as a reminder, I have lambda myeloma, meaning I get too many lambda light chains. In my last test, my lambdas were at 157, which was too many. So those Car-Ts are doing their job, and then some.

My M-band is dragging its feet, as it normally does. It would have been nice to see a big fat zero, but maybe that’s just me being greedy. It has only been a few weeks since the Cars were infused in. At least it’s on its way down.

I had my first of six planned monthly infusions of IV-IG, which is an infusion of antibodies. The Car-T cells kill off antibodies as well as the myeloma cells. They are programmed to search for cells that have the BCMA protein, which both myeloma and regular plasma cells have. Which is also why I’m becoming immune compromised again. Although my neutrophils are now over 2, which is in normal range.

I had the nurse put in an IV to draw my blood and then set me up on the IV-IG to save myself a hole.

“This is not how we typically do this”, she informed me. “Usually you have your labs done in the lab, and then a nurse sets you up with an IV once you are in the infusion chair”.

“Sorry for the trouble,” I said.

I believe that doctors and nurses are so exposed to medical things, they get desensitized and set in their ways. They forget that a patient could be doing something for the first time (not that I was) or what could be best for a patient.

It’s just a very human response, so I wasn’t upset or anything. It was just a good reminder that everyone is human, doing human things, no matter who they are or what their job is.

When I was in sales years ago, I got very desensitized to spending other people’s money. Spending 5-10k of someone’s money was no big deal for me. It was an interesting learning experience for me once I realized it, and I started putting myself in other people’s shoes more often.

Besides, I refuse to be a typical cancer patient. If I was, with my myeloma genetics, I would have been dead years ago. Let’s see if I can get my atypical T cells to get rid of the myeloma, more than typical.

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MRD Zero Sauce

My cells came back last week. From collection to arriving back here, it was about 4 1/2 weeks, which was quicker than the doctor was expecting. All of a sudden there is a flurry of medical things happening. Lots of tests, lots of meetings and driving everywhere for it all.

I have dates for everything now. 3 days of lymphocyte depletion next week. My Car-T infusion is set for August 26. Hospitalization a few days after that.

Today, I’ve been having a lot of meetings about all the drugs they want me to take.

“You’re going to take this drug for this, and it’s going to make you feel like crap”.

“And you’re going to take this drug for that, and it’s going to make you feel like crap”.

“And this drug over here, that’s going to make you feel like crap as well”.

I’m starting to feel like crap just listening to how crappy I’m going to feel 😜. This is all without even counting the side effects from the Car-T.

Sigh, modern medicine, it’s really good at making you feel like crap. “Feeling too well? Well, we have a medicine that can fix that!” Too bad nobody has that problem…

It will be an interesting and intense process. I hope the end result is what I’m hoping for. My doctor told me a few days ago that he wants me to leave from the hospital and the infusion center to be at MRD zero. Which is also my goal (MRD zero is zero myeloma cells detected in my bone marrow). Afterwards I was thinking, if I didn’t achieve that from the Car-T, how would he achieve that?

“Jothi, you haven’t reached MRD zero yet, so we are going to give you and extra portion of MRD zero sauce on your food to get you there!”

Speaking of food, I had some myeloma labs done. I haven’t had any done for about 2 months. I was expecting the numbers to keep elevating at the same rate. When I was on carfilzomib and dara, my light chains were going up 12 a week. As I mentioned in my CAR-T post, when I stopped the chemo, things slowed down a bit.

In the past 2 months, I went up 16 points total! 8 a month. That gave me an unexpected shot in the arm. Again, I find it weird that the cancer was progressing faster when I was receiving treatment. My theory is that the chemo was punching down my system, which must be dealing with the myeloma on some level. Once I recovered, the myeloma went back to a crawl. Diet, exercise and de-stressing are making a huge difference for me.

Which gives me quite a lot of hope for Car-T, since I won’t have any maintenance drugs to punch me down. The cancer will die and hopefully diet, exercise and de-stressing can help take care of the rest, or at least make whatever is left over myeloma’s life miserable.

Turmeric, green tea and broccoli for the win. I’ll go over more of that in my upcoming post, My Car-T Strategy.


P.S. I forgot to mention that the maybe/maybe not tumor on my spine hasn’t shown up physically inside or out, so I’m leaning towards it not being there.

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CAR-T

I had a few more blood tests and they confirmed that I have relapsed. The myeloma is starting to party inside of me. I was surprised by how quick my light chains and m-band ratcheted up on the first blood test. Things have slowed down a bit. Seems like I’m going up about 6-8 points a week with my light chains. Which is funny, the myeloma grew at a faster rate when I was on chemo (12 points a week) versus not being on it. (I did light chain math 🧮)

As you can imagine, I’ve been having a lot of doctor conversations and from that lots of tests. I am definitely starting to have medical fatigue from it all.

I decided to sign up for Car-t, which is genetically engineering my T cells to go after the myeloma. I was referred to UCSF. My myeloma specialist is from UCSF, so he instantly told my oncologist he wanted to take me on, which was nice for a change.

I decided to go with Carvykti Car-t. I had two choices of Car-t products. One that didn’t have many side effects but didn’t work as well, or Carvykti which works a lot better against the cancer but has a bigger potential for some nasty side effects.

I find that cancer is full of impossible choices, with a lot of the time having to choose between the lesser of evils. I do feel optimistic about Car-t therapy though. In my opinion, I think it’s probably the best treatment option for myeloma out there. I felt I had to swing for the fences with Carvykti. I’m starting to feel like I’m running out of treatment options. My specialist said he has some patients that are 5+ years myeloma free from Car-t and it’s starting to look like a cure for them.

I had a Pet scan this morning to look for cancer lesions. The myeloma specialist said if it was all clear that I could potentially not have to do any bridging chemo between from when I have my cells collected and infusion time, which is about a month. It came back as I’m writing this and it is all clear! Yay for exercise, meditation, carrots, mung beans and broccoli (or maybe just luck)!

I had my last chemo infusion 5 weeks ago. I’m having my T-cells collect on July 8, and it’s about 6 weeks to engineer them and send them back. So if I don’t need bridge chemo, that’s a good couple of months without chemo. I sure my body will appreciate that.

Someone asked me if I’m nervous about being off of chemo for a while as I have active myeloma now. I’m not really.

I took myself off maintenance chemo about 3 years ago after I got covid and had to stop. I saw that the chemo actually wasn’t doing anything. The myeloma was just poking along, rising about 10 light chain points a month. This time it is growing faster, but hopefully I can make it until my anti-myeloma army get infused back in.

I’m trying really hard to keep my expectations in check. It’s so easy to look at the amazing data (potentially cured) and hope for that myself. I know full well that this treatment could easily flop and be back in this same spot or worse (looking at you neurological problems 😡).

Pray for the best, prepare for the worst?

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Labs 5/17/24

Well, I had some bad news from this last set of labs 😔. My lambda light chain went from 10 (normal) to 100 (abnormal) in two months. So that was a big jump for me. For non-myeloma people, having your light chains rise like this means the cancer is active again. In the past, my light chains went up 8 to 10 points a month, so 45 points a month was a change.

I wonder if my stem cell transplant killed off something in my that held it better in check. Or maybe my frozen shoulder with its inflammation contributed. Hard to know, not that it matters a whole lot. It is what it is. I already had a regular scheduled appointment with the myeloma specialist next week, so that will be an enlightening conversation.

I feel like a treatment change is on the horizon for me. I feel a bit conflicted or discouraged by it. Meaning that the treatments that I have been doing for maybe a month or more haven’t been doing much, and I’ve been miserable for a few days each time for nothing. As well as the new treatment is probably going to involve staying at a hospital for a little bit, no matter what route I take, so that’s a bit of a bummer.

That’s how my life goes, I’ll just keep walking……

You can’t always control what happens, but you can control how you react.


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The First Post

Well, where to start? My name is Jothi (pronounced Joe-T). I’m married for 20+ years at this point, and we have 4 children aged 12-19. I am a big nature person. I love spending time outdoors, gardening, hiking, going to the beach, exploring. I am also a huge gamer. Games of any type, board games, sports (both playing and watching) and occasional video games.

People who I would like to sit down and have a long conversation with are in no particular order: Dalai Lama, Barack Obama, Warren Buffett, Anita Moorjani, Neil McKinney, Shin Terayama, Ryan Reynolds, Michael Jordan, John Stewart, Helen Jane Long and Steve Kerr.

For my myeloma family out there, I have Lambda Light chain myeloma. Which means I have too many lambda light chains that make up my blood for everyone else. I have the 14;16 translocation in my myeloma genetics, which basically means my myeloma is smarter than standard myeloma and is good at side stepping drugs.

I had 2 lesions when I was diagnosed, one on my 7 rib on my right side and a bigger one on the right side of my sacrum. Sometimes, I think about tumor placement in the body, and while there are worse spots than the sacrum, the sacrum is a terrible spot to have a tumor! I don’t recommend it. That’s the spot where your spinal cord fans out in a fantastic web of nerves. To this day, it’s like a little bird sitting on my shoulder poking me, saying, cancer, cancer, cancer.

I have had radiation on my sacrum and I went through the VRD chemo protocol (Velcade, Dex and revlimid). I elected not to do the stem cell transplant at that time. My lambda light chains at the high point were 470 and my Kapp/Lamb Fr was .01. M-band was 1.4.

About a month ago I started on Dara sq, Pom and Dex. As of last blood draw, my Lambda light chains are 142.52 Kappa Light chains 5.70 and KAPP/LAMB FR is .04. My M-band is 1.4. These numbers are after being off of all Chemo for over 6 months after I had a go with covid and saw that the chemo wasn’t doing anything anyhow.

I’ve had 2 pet scans this year, with the most recent in July. Both have come back showing no cancer activity.

I have become very passionate of diet, nutrition and what actual food is along my brief journey. When I was struggling for a website name, my kids suggested: Eatyourvegetablesdotcom, but it was already taken. But it is definitely my motto.

That’s the gritty numbers post with the information download. I hope my future posts will be a bit more fun and entertaining.

EAT YOUR VEGETABLES!!!