I recall first encountering the word 'potpourri' as a category on the game show Jeopardy when I was a kid.  I wasn't sure what the word meant because the an­swers that came up in that category never seemed to have anything in common.

Years later, I came across jars of foul-smelling bits of dried plants that were also called potpourri.  My curiosity was roused because I had no idea how this related to what I had seen on Jeopardy. So I looked up the definition and discovered that potpourri is basically a random collection of stuff (my paraphrasing of the dic­tionary’s definition).

Everything made more sense then, but I decided this was one of those words that while interesting, probably wouldn't be of much use unless I was looking for something to mask the odors in a bathroom.

As I've accumulated ideas for columns, though, I realized potpourri would be an appropriate title for a column covering several questions I’ve considered writing about in my column, but didn't seem to warrant a column in and of themselves.

So, without further ado …

Why is treatment so ordered and regimented?

One of the problems with treatment is that cancer becomes resistant to chemo over time. An advantage of multi-drug treatment is it makes it more difficult for cancer to adapt.  Therefore, why not mix up treatments, or mix up the frequency with which treatments are given, similar to the principles of muscle confusion used in strength training (e.g., cancer confusion)?

For example, I was treated on a 28-day cycle.  I received Kyprolis ^[1] (carfilzomib) on days 1, 2, 15, and 16, Rev­limid ^[2] (lenalidomide) on days 1 to 21, and dexamethasone ^[3] (Decadron) on days 1, 8, 15, and 22.  I would be curious to see a study to determine the efficacy of treating patients less predictably and with other drugs mixed in.

I do something similar with my weight lifting where I break my lifting into six different sets of exercises and group any three together for my workouts each week, never repeating the same combination two weeks in a row.  I also vary the amount of weight I lift and therefore the number of repetitions I do.  I've been doing this for over a year now, and the results have been superior to routines I've used previously.

Why are, according to some statistics, people over 65, more men than women, and more African-Americans than whites likely to get multiple myeloma?

I can't help but wonder about these statistics, particularly the first and third.  Given all the people I know with multiple myeloma, most seem to be younger than 65, and I have yet to meet one African-American with mul­tiple myeloma.  Is this just indicative of the communities I'm part of, such as The Myeloma Beacon, or the patients receiving treatment through the University of Michigan, or the support groups and conferences I've attended?

I also wonder if more people under 65 are being diagnosed due to better diagnosis techniques, or perhaps because more people with monoclonal gammopathy of undetermined significance (MGUS) or smoldering myeloma are being diagnosed, or perhaps people are being exposed to agents that cause multiple myeloma sooner than people use to be?

Do patients relapse after an autologous stem cell transplant because the cancer was not fully eradicated from their body prior to reintroducing their stem cells, or because the cancer is present in the reintroduced stem cells?

This topic has already been discussed in the Beacon ^[4] forums. It appears the relapse is due to residual disease still in the body, since a study showed virtually no difference in survival based on whether the harvested cells were purged of cancerous cells or not.

So now my question is whether the residual disease in the body is in the form of stem cells that were not killed off prior to the transplant, or is the source of the cancer something other than the stem cells and the transplant is just attacking a byproduct of the cancer, and not the source itself.

But if that's the case, why is a donor (allogeneic) transplant a potential cure?  Shouldn't the source of the cancer still be present when the donor stem cells are introduced into the body?  Perhaps the donor stem cells prevent the source of the cancer from proliferating any more because there is a crucial link or com­pati­bility required between the source of the cancer and the stem cells.

Speaking of allogeneic transplants: I also wonder whether one could be at risk of reacquiring multiple myeloma through a donor transplant if the donor has multiple myeloma.

Has anyone thought about how some of the money spent on multiple myeloma research could be spent more wisely?

For example, I came across the following study:

Physical Activity Declines After Myeloma Diagnosis - Results of an Australian study show that levels of physical activity decline after people are diagnosed with multiple myeloma. The researchers identified fatigue, injuries, and pain as the strongest perceived barriers to participation in physical activity.

Well, duhhh!  This seems to be another example of money spent on verifying common sense.  Anyone that's been on chemo, or has experienced the symptoms of this disease could easily have told them this.

Other examples of research I've come across include a study indicating patients handle pain better if they participate in a pain management program and a study indicating patients with MGUS or smoldering myeloma are more likely to eventually be diagnosed with active multiple myeloma than those who don't.  Perhaps I could have found enough examples like this to fill a column.

Hopefully my potpourri hasn't smelled things up too bad.

Peace, and live for a cure.