SERUM PROTEIN ELECTROPHORESIS: COMPARED TO 6/1/09, NO SIGNIFICANT CHANGE IN PREVIOUSLY CHARACTERIZED (2) IgA-LAMBDAS FROM 0.25 TO 0.26 G/dL AND FROM 0.19 TO 0.15 G/dL.

The two m-spikes have been staying this way for several months now. The complete bone survey report says, “No
aggressive lytic or sclerotic osseous lesions.”

Good, eh?

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“All four of the North Carolina patients were hospitalized and were very ill with underlying severely compromised immune systems and multiple other complex medical conditions, according to researchers from the Duke University Medical Center. Three of the four died. No details have been released about how the patients caught the resistant virus or whether there was any contact among them.”

Maugh II, T.H. (2009, November 20). Swine flu seems to be trailing off — for now, at least. Retrieved from http://latimesblogs.latimes.com/booster_shots/2009/11/swine-flu-seems-to-be-tailing-offfor-now-at-elast.html

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It seems like the flu (seasonal and H1N1) is getting all the attention lately.  Have a look at this article to take your mind off of it all: Don’t Be a Statistic

Myeloma Treatment

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To: Duke University Health System Patients

From: William J. Fulkerson, M.D.
Senior Vice President, Duke University Health System

Date: September 16, 2009

Re: Influenza Preparedness: Advice to our Patients

Dear Duke Patients,

As we approach the official beginning of autumn, we are entering the annual cold and flu season. This year’s flu season is expected to arrive early, stay late and be more intense than the flu seasons we have experienced in the recent past. The H1N1 influenza pandemic (aka “swine flu”) continues to intensify throughout the world, and public health officials fully anticipate a second and third wave of illness similar to what was experienced in the spring of 2009. Given the magnitude of health implications the flu can have on individuals (and their families), Duke Medicine is recommending the following steps to stay well this fall and winter.
Understand the facts about the flu. The H1N1 (aka “swine flu”) and seasonal flu are contagious respiratory illnesses caused by influenza viruses. They are spread mainly from person to person through coughing or sneezing and less commonly by touching a contaminated surface. The circulating strain of H1N1 causes an illness pattern similar in severity and duration to typical seasonal flu in most patients.
Know if you are in a high-risk group for complications from influenza. The high-risk groups for complications from H1N1 and seasonal influenza are similar. The major difference is that pregnant women and younger patients seem to be at a slightly higher risk to contract H1N1 (possibly because older patients have developed immunity to similar viruses over the years). The following are high-risk groups whose Duke health care provider should be contacted immediately if they become ill with influenza like symptoms: children less than 5 years old, pregnant women, adults and children who have chronic illnesses or compromised immune systems, persons aged 65 years or older, residents of nursing homes and other chronic-care facilities.
Understand the symptoms associated with the flu. Seasonal and H1N1flu symptoms are indistinguishable. They include: fever, sore throat, chills, body aches, cough, runny or stuffy nose, diarrhea, vomiting and headache. Please note that many of the recommendations regarding when it is safe to return to work or school are based on knowing your body’s temperature. If you don’t have a thermometer in the house, consider purchasing one now.
Understand when to seek medical care. Most patients recover from the flu completely in a few days and do not require a visit to their health care provider. But it is important to know when you should seek medical care. Flu symptoms typically resolve in 5 days, but if your symptoms persist beyond 5 days, contact your primary care doctor. If you have any of the following potentially life-threatening symptoms while battling the flu, immediately contact your health care provider or go to the closest Emergency Department: difficulty breathing or shortness of breath, pain or pressure in the chest or abdomen, sudden dizziness, confusion, severe or persistent vomiting, flu symptoms that initially improve but then return with cough and fever. Infants should be taken immediately to the Emergency Department if there is a bluish or gray skin color, lack of responsiveness or extreme irritability.
Get a seasonal flu shot! The seasonal flu vaccine is the single best way to avoid getting the seasonal flu. It does not protect you from the H1N1 (aka “swine”) flu, but is highly effective against most strains of the seasonal flu. Duke Clinics will begin offering seasonal flu shots as early as mid-September this year. By obtaining your flu vaccine well before the peak of flu season, you give your body the ability to build immunity to the flu before you are exposed. It takes about two weeks for your body to fully build its defenses after receiving the vaccine.
Consider getting the H1N1 vaccine. This year in addition to the seasonal flu vaccine there will be a separate vaccine for H1N1. This may be a one part or two part vaccine aimed directly at the circulating H1N1 influenza virus. The vaccine is highly recommended (and will be prioritized) for pregnant women, people who live with or care for children younger than 6 months of age, health care and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people ages 25 through 64 who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems. Once there is adequate supply of the vaccine, we encourage all patients to get vaccinated. Talk with your health care provider about when you should be vaccinated for H1N1.
If you’re sick, stay home! The flu is spread when an infected individual coughs and sneezes. Once it is in the environment, the rest of us can get from handshakes, by simply being in close contact with someone who is infected, or by touching contaminated surfaces. If you come down with flu-like symptoms, stay home (away from other people) until at least 24 hours after your fever has naturally resolved.
Wash your hands frequently. Frequent hand washing is a simple activity to avoid a multitude of infections – including the seasonal flu, swine flu and the common cold. Wash your hands well using soap and water; alcohol-based hand gels are a good alternative when you are away from a sink. Avoid touching your eyes, nose and mouth, as these are the routes of entry for cold and flu viruses into the body.
“Eat right and sleep tight. Stay hydrated.” Diet and sleep patterns have a profound effect on your body’s ability to fight infection and disease. Eating green, red and yellow fruits and vegetables and sleeping a minimum of 8 hours a night boosts your body’s immune system. A healthy adult needs to drink about 64 ounces of water each day.
Stay calm and don’t panic. Pandemics can be scary times – but rest assured the federal, state and county governments and Duke University Health System are all working together to address this pandemic. Duke Medicine is committed to helping you and your families stay healthy this cold and flu season. Please do not hesitate to visit www.dukehealth.org/flu for updates on the flu season, or contact your health care provider with questions.

William J. Fulkerson, MD

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IMMUNOGLOBULIN PROFILE
                                                             Reference
  IMMUNOGLOBULIN G                  *410         mg/dL       [588-1573]
          TEST REPEATED TO CONFIRM
            NOTE:  African-American reference ranges differ slightly from
                   those listed.  Please call the Immunology Lab at 684-6939
                   for race specific ranges.
  IMMUNOGLOBULIN A                  *432         mg/dL       [46-287]
          TEST REPEATED TO CONFIRM
  IMMUNOGLOBULIN M                  *26          mg/dL       [57-237]
  IMMUNOGLOBULIN E                   30          IU/mL       [4-269]

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SERUM PROTEIN ELECTROPHORESIS
                                                             Reference
  SPE INTERP
   COMPARED TO 2/10/09, NO SIGNIFICANT CHANGE IN PREVIOUSLY
  CHARACTERIZED (2) IGA-LAMBDA COMPONENTS FROM 0.21 TO 0.25 AND
  0.14 TO 0.19 G/DL.
  "I have personally performed the interpretation".  Dr. S. Pizzo, MD,PhD

  SPE TOTAL PROTEIN                  6.8         g/dL        [6.0-8.0]
  SPE ALBUMIN %                      65.6        %
  SPE ALBUMIN                        4.46        g/dL        [3.97-5.34]
  SPE ALPHA 1 %                      2.9         %
  SPE ALPHA 1                        0.20        g/dL        [0.11-0.32]
  SPE ALPHA 2 %                      10.5        %
  SPE ALPHA 2                        0.71        g/dL        [0.40-0.88]
  SPE BETA %                         11.3        %
  SPE BETA                           0.77        g/dL        [0.60-1.02]
  SPE GAMMA %                        9.7         %
  SPE GAMMA                          0.66        g/dL        [0.53-1.37]
  SPE M-SPIKE 1 %                    3.7         %
  SPE M-SPIKE 1                      0.25        g/dL
  SPE M-SPIKE 2 %                    2.8         %
  SPE M-SPIKE 2                      0.19        g/dL

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Just before the meeting at the Lemur Center, I had a checkup at the Bone Marrow Transplant Clinic.  I’ll have the results of my tests on Wednesday.   It’s been almost two years since I had a skeletal survey, so I scheduled that for September.  The skeletal survey is a series of xrays of the long bones, skull and ribs and spine. I asked about a recent report I read that suggests that PET scans should be used for monitoring myeloma.  My doctor does those if there’s activity such as an increasing m-spike and nothing shows up on xrays.  The PET can show plasmacytomas and other activity.

I’ve been told that standard radiographs aren’t much good at detecting bone damage until there’s been a significant amount of destruction, so it’s not a good early warning indicator. I’d like to have a PET scan just to see what’s lurking.  I know they’re expensive.  A few years ago I called around to get the costs at various places  because I wanted one, but was told by my insurance company that they weren’t covered for myeloma. At the time, the cheapest PET scan I could find was about $3,000.

Did you know you can do that?  If you’re not insured, or your coverage isn’t very good, call around to see who has the best deals on tests or procedures.  The costs can vary quite significantly between institutions.  Another money-saving tactic is to find out what’s covered under what setting.  For example, my insurance has me pay 20% of services performed in hospitals.  That’s why I have most of my chemo and all of my Zometa infused at a nearby doctor’s office.  When I do that, it’s just a $30 copay. Investigate all of your options!

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We are currently looking for people that have suffered “oral mucositis” (mouth inflammation or sores) as a result of cancer treatment to participate in 45 min telephone interviews.

The purpose of this research is to understand what does or does not work as treatment for this condition.

The interviews can be scheduled this week and next and participants receive $100.

Please respond with interest to contacts below. If this is not you, please refer or post for others that may have interest.

Kind Regards

Jan Mallery-Groom RN
Clinical Project Manager
+510-922-9710
recruitingresourcesllc.com

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These labs were done 12/08/2008

IFE SERUM
(2) MONOCLONAL IgA-LAMBDAS DETECTED BY IFE.
SPE M-SPIKE 1                      0.17        g/dL
SPE M-SPIKE 2                      0.12        g/dL

IG FREE LIGHT CHAINS SERUM
                                                         Reference
  IG FREE LIGHT CHAIN KAPPA         *0.16mg/dL       [0.33-1.94]
  IG FREE LIGHT CHAIN LAMBDA         1.85mg/dL       [0.57-2.63]
  IG FLC KAPPA/LAMBDA RATIO         *0.09            [0.26-1.65]

IMMUNOGLOBULIN PROFILE
IMMUNOGLOBULIN G                  *374mg/dL       [588-1573]
TEST REPEATED TO CONFIRM
IMMUNOGLOBULIN A                  *415mg/dL       [46-287]
TEST REPEATED TO CONFIRM
IMMUNOGLOBULIN M                  *31mg/dL       [57-237]
TEST REPEATED TO CONFIRM
IMMUNOGLOBULIN E                   13 IU/mL       [4-269]

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Multiple myeloma flame shaped plasma cell (UVA photo)

Gene Variants Can Predict Early or Late Mortality in Multiple Myeloma
Elsevier Global Medical News. 2008 Nov 11, MG Sullivan

Genetic variants in the DNA of patients with multiple myeloma appear to strongly influence survival, a groundbreaking new genomic study has concluded.

In this first pass at identifying genetic markers for survival, treatment response, and complications in the disease, a group of 3,400 variants predicted early or late mortality 76% of the time, Dr. Brian Van Ness said in an interview about the initial report (BMC Medicine 2008 Sept. 8 [doi: 10.1186/1741-7015-6-26]).

“Clearly, inherited genetics influenced survival,” said Dr. Van Ness
of the University of Minnesota, Minneapolis. “What we have not yet done is identify which specific variants are responsible for these differences. Our hypothesis is that it won’t be a single variant driving response or survival, but a complex interaction of many.”

After narrowing down the initial 3,404 candidate single nucleotide polymorphisms (SNPs), Dr. Van Ness and his colleagues are now focusing on 1,000 SNPs found to be most strongly associated with the outcome
measures. More studies are on the way using this genetic panel, he said.

Indeed, just 2 weeks after the first study appeared, a coinvestigator, Dr. Gareth Morgan of London’s Royal Marsden Hospital, published findings on the association between certain SNPs and the incidence of
treatment-associated venous thromboembolism (VTE). The analysis showed that some of the variants associated with thalidomide-related VTE occurred in pathways important in drug transport and metabolism.

“The effects of the SNPs associated with thalidomide-related VTE may be functional at the level of the tumor cell, the tumor-related microenvironment, and the endothelium,” Dr. Morgan and his colleagues wrote (Blood 2008 Sept. 19 [Epub ahead of print]).

“Another study, currently submitted, has identified an association between some of the variants and the development of severe myeloma bone disease,” Dr. Van Ness said.

The initial investigation used a genetic screen developed from two DNA data sets: cells from the Coriell Institute for Medical Research, and samples obtained from multiple myeloma patients enrolled in two
randomized drug trials, as well as some unaffected spouses. The samples came from white, black, Hispanic, and Asian patients from North America and Europe. The candidate SNPs, occurring on 983 genes, were chosen based on the most recent genetic research and included on a myeloma-specific gene-testing chip.

The investigators chose extremes of survival as the first test of the panel, because this comparison was most likely to show the effects of any genetic variant. “We took the worst outcomes – people who died in
the first year of their disease – and the best outcomes – those who survived at least 3 years without progression,” Dr. Van Ness said. After repeatedly running the screen on both data sets, the team concluded that, as a whole, it discriminated the survival groups correctly 76% of the time.

Further drilling down identified several SNPs of particular interest, including some associated with drug metabolism, transport, and export; a variant that induces myeloma apoptosis; one associated with cellular
migration and angiogenesis; and several linked to proliferative responses.

Although not designed to detect racial differences, the initial screen did identify some interesting variations: 401 of the SNP variants occurred only in black patients. In whites, there was no difference in these SNPs between cases and controls.

“We know that African Americans have a two- to threefold increase in the incidence of myeloma, but we don’t yet know why,” Dr. Van Ness said. “We’ll be trying to identify those genetic variants that might uniquely increase the risk for one race to develop myeloma over another.”

Neither this initial analysis nor subsequent ones will examine the possible interplay of environment with genetics. But, Dr. Van Ness said, such studies may be forthcoming. The International Myeloma Foundation of North Hollywood, Calif., is conducting a patient survey to begin assessing what role – if any – environmental exposure plays in disease development. The 36-page survey asks patients to detail their environmental, dietary, and geographical exposures. The National Cancer Institute will collaborate with the group in evaluating the data.

The International Myeloma Foundation is also the curator of the DNA samples used in the analysis through its Bank on a Cure program. “Bank on a Cure was developed by an international group of physicians and scientists to deal with a disease that’s difficult to deal with,” Dr. Van Ness said. “It’s not a high-incidence cancer, so it’s not easy to research.”

The Bank on a Cure group developed cooperative agreements with national and international clinical trial groups, and the studies were funded by the International Myeloma Foundation. While exploration of genetic variants relevant to multiple myeloma is in its infancy, Dr. Van Ness predicted the effect could be profound.

“It’s already fairly well established that the genetics of the tumor cells themselves impact response and survival,” he said. “But beyond this is the impact of every individual patient’s genetics – how they absorb, distribute, metabolize, and export drugs, even what race they are. If we understand why someone doesn’t respond to a drug, we could better target their therapy. If we could predict which patient might develop a life-threatening blood clot during treatment, we could take steps to prevent it.”
Copyright © 2008 International Medical News Group

Source: http://www.oncologystat.com/news-and-viewpoints/news/Gene_Variants_Can_Predict_Early_or_Late_Mortality_in_Multiple_Myeloma_US.html

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