Good Blood, Bad Blood

“Genes are like the story and DNA is the language that the story is written in.”

Sam Kean, The Violinist’s Thumb

Recently, I traveled to Portland, OR for my monthly multiple myeloma support group meeting. In the course of the last 3+ years I have solidified friendships with several other members. We know much of each other’s cancer story. Before and after the meeting, we make time to catch up on the myriad developments in our treatment.

This meeting featured none other than my own oncologist, Dr. M. He delivered a presentation based on the latest research from the American Society of Clinical Oncology. In keeping with recent trends, ASCO revealed further evidence of drugs that may soon be available to fight myeloma.

The percentage of patients responding to trial protocols impresses those of us with MM. Survival times creep forward as researchers find diverse ways to suppress the malignant plasma cells. Still, it’s easy to become sedated by the minutiae of clinical trials. After discarding the chaff of numbers, two clear messages about the status of our disease remained: the search for curative solutions continues to progress, but ultimately, nearly all MMers relapse.

Dr. M explained this situation by noting that myeloma is a genetically complicated disease. He drew a comparison with chronic myologenous leukemia. CML patients, due to the discovery of Gleevec, enjoy a high rate of cure for this once deadly cancer. The biology of CML is simpler than that of MM. In CML, a specific enzyme in white blood cells is locked in an activated form. This causes the excessive proliferation and high white blood cell count characteristic of the cancer. Gleevec, binds to the site of the enzyme and prevents its activity, causing tumor cell death.

The genetic intricacy of MM does not lend itself to such easy remedies. While Gleevec can focus in on the single weakness in CML, multiple myeloma has a more sturdy biology. It is smart. It finds its way around blocked pathways in order to continue cloning itself. Currently, targeted therapies don’t exist because the target cannot be found.

Novel agents, such as revlimid and velcade, suppress the tumor burden but these drugs are broad-spectrum cell killers. Their specificity leaves something to be desired. Relapse occurs because cancer cells that are genetically resistant to a drug outgrow all the nonresistant cells.

One of our support group members, K, introduced Dr. M. Her husband was a patient of Dr. M for six years. Last year his MM took an aggressive turn. All attempts to stifle the cancer failed and he passed away early in the winter of 2011. Her husband was a Buddhist. Many members of our group, as well as Dr. M, attended the traditional and moving ceremony held at his temple in Portland.

In spite of her loss, K remains committed to our group. She utilizes her background in graphic design to prepare meeting announcements. She also writes a caregiver’s blog for the International Myeloma Foundation. And, she was instrumental in getting Dr. M to speak with us. K’s testimonial to Dr. M spoke to the high regard in which colleagues and patients hold him.

Obviously, doctors cannot fight our battles for us. Dr. M is a clinician, not a researcher. He will not discover the cure. However, the quality of his caring matters. Compassion has healing attributes. It may not mend the body, but it can protect our soul as we brawl with the biology of MM.

Eventually, a pharmaceutical like Gleevec may unravel the mysteries of multiple myeloma’s DNA. Truly, the best is yet to come. In the meantime, individuals such as Dr. M and K illustrate that care giving is also a powerful drug. Injecting a heavy dose of dignity into the heart and mind of another person has no adverse side effects. You don’t need insurance or a prescription. Furthermore, a clinical trial is not necessary to evaluate how it improves the quality of life. It just works.