Good Blood, Bad Blood

A blanket of overcast sky lies across the state of Oregon from November to March. Intermittently, the colorless clouds darken and rinse the northwest with showers. I continue with my six-mile walks but, in such a climate, it helps to also have sedentary activities.

I love to read. In fact I’m an inveterate reader; I always have a book or two or three at hand. My tastes are eclectic, but once the rains arrive, I feel an urge to curl up with a good mystery. Few things cheer me more than a cozy chair, a cup of hot tea, and the search for a ruthless serial killer.

My favorite mystery writers are the phlegmatic Europeans, in particular, the Swedish couple, Per Wahloo and Maj Sjowall. This husband and wife duo co-authored several classic police procedurals; The Laughing Policeman, The Fire Engine That Disappeared, and The Locked Room, to name just a few. These date back to the 60s and 70s but their skill at creating tense realistic puzzles transcends the generations.

Wahloo and Sjowall composed tales driven by the characters, not coincidence, guns, or sex. Instead, the detectives ruminate on the smallest of clues. Slowly they build a scaffold of facts that assist them in reaching a solution. All the while we peer at the inner workings of their imperfect personal lives, conducted under the pall of Nordic winters. Simply put, their imaginative problem solving occurs in the most uninspiring of circumstances.

Good medical research proceeds in much the same way. It’s a plodding and unglamorous career choice. It too relies on the assembly of facts gleaned from doggedly pursuing clues down theoretical rabbit holes. Many of these lead to dead ends. Eventually, though, the puzzle pieces begin to fit together.

Serial killer whodunits, such as multiple myeloma, a cancer with which I am afflicted, are slowly being solved by determined clinicians. Fortunately, the perpetrators don’t shoot back. But these sociopaths, living in the otherwise ordered community of our blood system, find themselves being stalked, cornered, and eliminated.

Recently, the Leukemia and Lymphoma Society treated my MM support group to a presentation from Dr. James Berenson. It’s fair to say he possesses the skills of a good detective: a patience and persistence necessary to catch a wily foe such as MM.

Dr. Berenson is the founder of the Institute for Myeloma and Bone Cancer Research and one of the world’s foremost authorities on multiple myeloma. The title of his presentation was Myeloma Treatments: Pacing Yourself for the Future.

Some highlights from his 90-minute talk:

1. He no longer recommends stem cell transplants in his practice. New drugs and their combination with other established drugs provide strong responses with less toxicity and side effects. He pointed out that multiple myeloma is a slow moving disease of the bone marrow. Therefore, it is illogical to think you can sustain that environment over the long term if you bomb it with high-dose chemo and a relentless regimen of maintenance therapy.

2. He sees little difference in the quality of life between a stable disease and complete remission. He subscribes to the theory that “less is more” with regard to dosage with drugs such as revlimid and velcade and steroids.

3. He advises not dwelling on lab numbers. He said it is more important to focus on protecting one’s bones and kidneys than it is to strive to reduce the M-spike to zero. Accordingly, he recommends the use of bisphosphanates even in the absence of bone lesions.

The mystery of MM will be solved, or, so says Dr. Berenson. He explained what he believes are the tactics to help us survive. His advice is to pace our selves for the developing strategies that will ultimately lead to a cure.

Whether or not you agree with Dr. Berenson’s ideas, his optimism matches a common theme expressed by others in the myeloma medical community. Though their theories differ, all anticipate a solution to the puzzle of multiple myeloma. Will the momentum of their investigations continue? I don’t know the answer. I am, like many of you, a character in this story, a clue to the mystery.