Last week I had my regular clinic appointment at the end of my second cycle (month) of “consolidation” chemotherapy. This being “consolidation” to seek to deepen the response already achieved by my hospital treatment earlier this year (high dose melphalan and stem cell transplant). The particular chemical combination selected, as mentioned in my previous post, is Revlimid (aka lenalidomide) / cyclophosphamide / dexamethasone (“RCD”).
So far I have to say I’m loving the lenalidomide. Most important of course is the effect it’s having on the disease, and the initial results look quite promising. It takes a while for the blood test (assay) to be done to measure the level of “free light chains” in my blood, these being one of the key indicators of the disease that the treatment is tackling, and at the end of this second cycle the results from the end of the first cycle were available (from both Southampton and from the NAC in London) and both showed a significant drop in the free light chain level (Southampton of about 850mg/l -> 450mg/l and London of about 1800mg/l -> 600mg/l). The difference in absolute values between the two shows how lab / assay / calibration dependent the tests are, but the overall message is good. Hopefully that sharp downward trend can continue.
But the other good thing about the lenalidomide is that I don’t seem to be suffering from any side-effects in taking it. Best of all is the complete absence of the strong (in the doses I was taking) sedative effect of thalidomide, which manifested itself as a fuggy brain in the mornings (the thalidomide hangover) which tended to hang around for a while in the day too. I haven’t noticed any peripheral neuropathy (finger or toe numbness) either and I’m watching out for that pretty carefully as the thalidomide treatment has unfortunately left me with a bit of residual numbness in my toes, which is bearable but I wouldn’t want it to get worse.
So in fact far and away the most noticable effect of this RCD treatment is the dexamethasone “boost” (and lack of sleep) that I’ve mentioned several times before. Mind you, even that isn’t such a pain in this treatment, as my “dex days” have landed on a Thursday and Friday, so just as I’m getting to the end of the working week I get a little pick-me-up which I’ve found quite productivity-enhancing! I rather surprised one guy I was working with recently by discussing some material on a Thursday that I had to then turn into a long written document, which was done by Friday morning. I’d been up half the night doing it of course, but I was awake and my brain was buzzing, so it made sense to just crack on with it!