With Dr. T (Thertulian), her oncologist

Mary Lou Sartoris

First post: Apr 13, 2012 Latest post: May 24, 2017
Welcome to our CaringBridge website. We've created it to keep friends and family updated about Mary Lou's condition and her journey in the battle against multiple myeloma. Get started by reading this introductory entry.

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Nelson and Mary Lou

April 9, 2012

In August, 2010, during a routine physical, Mary Lou's blood work indicated the presence of a condition known as "smoldering myeloma". It is the second of three stages in the development of multiple myeloma, a cancer of the bone marrow.  

At the time, a bone marrow biopsy indicated that her bone marrow was 40-50% abnormal plasma cells. (A normal biopsy would show only about 1% healthy plasma cells in the marrow.)  For the next 12 months her condition was monitored monthly.  During that time she fortunately exhibited no symptoms, however, her blood numbers rose at a slow, but steady upward pace.  Typical myeloma symptoms include bone brittleness and lesions, anemia, and kidney malfunction. Another bone marrow biopsy in August, 2011, showed 60-70% abnormal plasma cells. In the seven months since then her numbers continued going upward, but she remained symptom free. 

Her most recent bone marrow biopsy in March, 2012, indicated a very high 80-85% abnormal plasma cell involvement in her marrow. Although she has still been incredibly fortunate not to exhibit any symptoms, recently published studies indicate that survival rates are enhanced in patients who begin treatment early, even if they are not yet manifesting symptoms. This information, coupled with the strong recommendation of her oncologists here in Asheville and at Duke, compelled Mary Lou to begin treatment today, April 9, 2012.  So far, so good, since she has not exhibited any side effects from this initial chemo treatment.

This initial treatment process, referred to as induction therapy, consists of a twice a week regimen of chemotherapy (Velcade) and oral steroids (Dexamethasone) to reduce the level of malignant plasma cells in anticipation of a likely bone marrow transplant.  This induction therapy will last at least several months and will be done here in Asheville. The actual duration of this induction therapy will be dictated by how well she responds.  

Two weeks ago we visited the bone marrow transplant unit at Duke.   We had previously visited UNC's transplant unit late last summer.  We were particularly impressed with the people and the facilities at Duke, so it appears that after this induction period she will go to Duke to begin the bone marrow transplant process. 

This extensive process at Duke involves first harvesting her own stem cells for subsequent re-infusion. If she opts for the transplant path at this point, they will strive to eradicate the remaining abnormal plasma-producing cells in her marrow (during which time she will be highly vulnerable since her immune system will be very compromised). They will then re-implant her stem cells and hope they take hold and produce new, healthy marrow, whereafter she will slowly regain immunity.  It is a difficult process, but the prognosis is good, and if successful, holds the promise of 10-15 years of a cancer free outcome.  

It is also possible, that if she responds exceptionally well to the initial induction therapy, they may just harvest her stem cells at this point, freeze them in case a transplant is deemed necessary later on, and just continue to treat her with newly available drugs as a maintenance therapy instead of doing a transplant right away.  She'll cross that bridge when she gets there.  

She is fortunate to have one particular genetic marker which indicates she will respond favorably to either treatment path, and none of the 6-7 unfavorable genetic markers.  While she is obviously anxious about the potential side effects of this initial treatment phase, she is trying to focus on this process as the positive first step of the journey she must undertake in order to emerge healthy and cancer free on the other side.  

In a strange way, she is relieved that the day-to-day uncertainty as to when treatment would begin is over and that she now can get on with the challenge ahead. 

We will keep you posted at this site on her progress as developments unfold.  Thank you for your concern.


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