Lately, I’ve been thinking about how myeloma treat­ment is like being a contestant on a game show. You never know what’s lurking behind the screens once you get called up from the audience. It could be a new car, or it could be a “wah-wah-wah.”

Today, my husband Daniel com­pleted his 3^rd cycle of Kyprolis (car­filz­o­mib), Revlimid (lena­lido­mide), and dexa­meth­a­sone (Decadron) for his multiple myeloma. In a week, he will have his next round of myeloma labs, and then we’ll meet with his myeloma specialist to discuss his progress. That’s when we’ll find out what’s behind “Door #4.”

Last month, we learned that Daniel had “only” achieved a partial response to ther­apy after com­plet­ing two cycles of his treat­ment. This month, after the completion of his third cycle, we will find out whether he has achieved a com­plete response.

Did you catch that? Only a partial response. When discussing his results with others, Daniel called it “mixed news.” He was concerned that this might indicate that the treat­ment wasn’t work­ing as well for him as we need.

The good news is that Daniel has already reached a partial response, which is the required minimum for him to be a can­di­date for the au­tol­o­gous stem cell trans­plant that his care team is planning for him in August. Also, as his stem cell specialist explained, while a deeper response is desired, less than 15 per­cent of his patients achieve a stringent com­plete response. So why are com­plete responses and stringent com­plete responses the goal? According to our specialist, some studies have shown that patients who achieve a com­plete response to ther­apy are more likely to have longer pro­gres­sion-free survival after stem cell trans­plant.

We’re into the sixth year with Daniel’s myeloma specialist, and we’ve learned to read her pretty well. Today, she is as calm and measured as always, but we sense her concern and we’re grateful for it. She has already come up with a plan for the fourth cycle of Daniel’s treat­ment, in case he needs it. To encourage a deeper response prior to trans­plant, she has requested pre-approval for Darzalex (dara­tu­mu­mab) from our insurance com­pany. It would be added to his current treat­ment cocktail if his myeloma labs do not show a deep enough response after his third cycle. The thinking is that between the Kyprolis (a proteasome inhibitor), and Revlimid (an immuno­modu­la­tory agent), dexa­meth­a­sone (a corticosteroid), and Darzalex (a mono­clonal anti­body), that this multi-pronged ap­proach might drive better results in com­bi­na­tion.

If he has not achieved a com­plete response and he is approved for the addi­tion of Darzalex to his treat­ment cocktail, our infusion time for his ther­apy increases another seven hours for the first infusion and about five hours for future infusions. This is on top of the 2.5-hour infusion of his current treat­ment that he receives twice a week.

Most days we find ourselves at the hospital for most of the day when he receives treat­ment because it takes so much time for his blood to be drawn and then analyzed prior to his infusion. Two- to four-hour waits are not uncommon for us, so by the time we get back to the treat­ment area for his infusion, it’s a long day. With Darzalex, it sounds like it will be even longer. I may need to invest in some noise canceling headphones and strategies to combat restlessness for my good “patient,” but all of that is a great bargain if we’re getting a com­plete response in exchange.

I understand that these end-of-cycle markers are just one of several mile­stones to come. As many readers have already ex­peri­enced, the final measure of response depth will be made after Daniel’s stem cell trans­plant. However, it hasn’t escaped our notice that these end-of-cycle markers measuring his response to treat­ment are guiding his treat­ment decisions, and they definitely have us thinking about the implications.

We hope that a stringent com­plete response is awaiting him at the end of all this and that we will have at least five years of pro­gres­sion-free survival before he has to do this again. By that time, who knows, the entire treat­ment landscape may have changed. Hopefully we’ll have found an easier way to treat this disease, if not cure it.

So, here we are waiting for next week. It never gets boring on this myeloma game show. We’re spinning the wheel, awaiting what’s behind “Door #4,” and hoping that it’s a com­plete response. I’m just glad that we get to play the game where we do, and that his specialist keeps the game plans coming.