In my first column ^[1] last month, I discussed my initial diagnosis of multiple myeloma as well as my decision to have treatment close to home and to go with a less aggressive approach.  Once this decision was made, it was time to move forward.

I was anxious to get going with treatment: get treated, go into remission, and be done with this whole thing, or so I thought.   I know, I read all about myeloma being incurable, but deep down I felt I could be different.

At the time I was diagnosed 5 years ago, Moffitt was doing a study for newly diagnosed patients.  It used two different protocols for induction therapy prior to stem cell transplantation, and I was given a choice of protocols.

One option was the standard therapy at that time and used traditional chemotherapy; known as VAD, it included vincristine ^[2], doxorubicin ^[3] (Adriamycin), and dexamethasone ^[4] (Decadron).  The other option included thalidomide ^[5] (Thalomid), which was fairly new at the time, and dexamethasone.

I mention this for two reasons.

The first is how was I going to decide between these two options?  The team at Moffitt did not seem to strongly favor one over the other in terms of the results. However, one of the biggest problems with thalidomide was the side effect of peripheral neuropathy (tingling and pain in the extremities).  I was a surgeon, planning to go back to work as soon as possible, and this was potentially a big problem.  My doctor factored this into the decision and steered me towards VAD.

Wow, I was impressed.  They were actually considering me as a person in the decision and looking toward a life after treatment.  This was the way I was going to go.

The second reason I mention this is to illustrate how rapidly multiple myeloma treatments are changing and how far we have come.  Neither of these treatments is really even used any more.  They were, in fact, considered outdated almost as soon as I finished my initial treatment.

Most of the new up-front regimens, of which there are many, include at least one or both of the newer, more active drugs, Velcade ^[6] (bortezomib) and Revlimid ^[7] (lenalidomide).

Do I feel that I may have missed out on something by not receiving these treatments up front?  Maybe a better initial response?  Maybe a longer remission?  Who is to say?

The good news about myeloma treatment is that if you don’t receive these drugs up front, they are available in the relapse setting.

For four months, I went through induction chemotherapy with VAD, one week on, three weeks off.  I continued to work during the weeks I was not on chemo.  I had no bad side effects, and the results were encouraging.  My M-spike (monoclonal protein level, which is a measure of the amount of myeloma protein in the blood) dropped from 7.5 to 0.5.  I had already achieved what is known in myeloma speak as a “very good partial response” (greater than 90 percent reduction in disease).

I was ready to move on to the thing that all the suspense had been built up over, the stem cell transplant, which I’ll write about next month.