April is the cruelest month, breeding
Lilacs out of the dead land, mixing
Memory and desire, stirring
Dull roots with spring rain.
T. S. Eliot
The coming of April teases the gardener in me. I long to sink glove deep into the warming loam. Yet a fresh skiff of snow spoils the mood. Cheerless breezes scour my yard. I doubled up on the bird feed for the disappointed foragers, who arrive like refugees from calamity: chubby quail, ravens, a diminutive chipmunk, querulous jays, towhees, an occasional sparrow, and, of course, the ubiquitous juncos.
Last fall I spread cartloads of leaves across my flower gardens. Colorful quilts of maple, birch, and poplar blanketed the perennials during their winter’s rest. December snows compressed the decaying cellulose. Later, cold rain leached their nutrients into the soil as I walked in circles around my rural neighborhood, recuperating from the transplant.
Sometimes I forget about my cancer. Yes, I know, once you have it, you got it. Yet lately, like our former president, I have moments when I misremember; I am utterly and happily oblivious of my illness. This, in spite of the fact I’ve overdosed on the science of cancer in recent weeks.
In addition to my regular support group meeting, I attended two educational workshops. The local chapter of the Leukemia and Lymphoma Society sponsored a presentation on ‘Serum Free Light Chain Measurements’. The event aimed its instructional arrow at oncology nurses but patients from our support group were welcome to attend.
My doctor leans on the SFLC assay to monitor the disease. Accordingly, I hoped someone could give me a magic number. Surely, there must be a point where the ratio between kappa and lambda light chains indicates treatment? Sadly, there is no such thing.
Tracking the ratio’s value provides a key that may open the door to a decision about treatment. You will see a change in light chain numbers prior to elevation of the M-Spike. Therefore, you’ve a head start upon entering the maze of choices. But interpreting the ratio to find the best way forward defies simplicity. Your doctor’s experience remains the predominant factor in determining what to do. Yet, even the best lead us down cul-de-sacs. Such is the confounding nature of this disease.
Several days later, The International Myeloma Foundation hosted a four-hour program. The latest research includes clinical trials of new drugs as well as unique combinations with older ones. The gist of this meeting, like everything I’ve heard and read these last several months, is that there is not yet a single best option. Oncologists and their patients, however, enjoy a glut of good alternatives. So much so, in fact, there exists confusion as to which protocol is best. We know more, but also understand there is now more to know.
Stem cell transplants continue to hold their own when you scrutinize the toxicity scales and survival curves. There is something to be said for the drug-free remissions obtained from a successful transplant. However, some drug combinations in Phase 2 and Phase 3 trials are delivering comparable response rates, even in cases where chromosomal deletions and translocations occur. This data is immature and it may be several years before we know if the remissions are sustainable. Eventually, these promising studies will unravel a definitive treatment plan, supported by data from easily understood diagnostics like the SFLC assay.
Some myeloma patients may survive long enough to take advantage of developing treatments. My disease, for example, has an indolent personality. The cancer is everywhere we look, but its lazy behavior makes me optimistic. Many of my compatriots, unfortunately, experience more active disease. Recently, two individuals from our myeloma network passed away after lengthy battles. Others endure unremitting symptoms or aggressive treatment.
The maelstrom between winter and spring figuratively captures all of us with myeloma. Contradictory urges to hunker down or go forth compete. I watch as March gales blow away the desiccated remnants of leaves from my slumbering flowerbeds. Wind chimes, swaying from the eaves above my porch, ring a refrain in rhythm to the bobbing branches of the fir trees, “What to do, what to do?”
Soon, when the wind quiets down, what I’ll do is till the soil in my yard. I’m planning a little victory garden: a row of spuds and another of tomatoes; perennials near the porch; wildflowers elsewhere in abundance and maybe something to attract butterflies.