1929 / Class of '91 / Type: Kappa / Died 5-3-2000
I was born and raised in rural areas of Southern California. I did not live near agricultural activities using pesticides. I left California at 20 years of age to meet my military obligation, serving two years in Germany in 1951-52. On returning from the army I attended the University of California at Berkeley. In 1955 I moved to Placerville, California to begin employment as a forester with the U.S. Forest Service. My employment took me to Placerville, Kernville, Weaverville, McCloud, and Susanville California between 1955 and 1968.
While at McCloud in 1964 I got caught under the spray of a helicopter spraying 2,4-D and 2,4,5-T to control brush in a tree plantation. This combination is better known as Agent Orange and was used in Vietnam. I mention this because the Veterans Administration recognizes it as an apparent cause for multiple myeloma in veterans who served in Vietnam.
In 1968 I moved to Springfield, Virginia for two years and then to Denver, Colorado for four years. I then moved to Grangeville, Idaho a farming community in north central Idaho. There was a heavy use of pesticides there and, what seems to me, an inordinate occurrence of MM. Following eight years in Grangeville, I moved to Missoula, Montana where I stayed for two years until my retirement in 1984 when I moved to Lewiston, Idaho where I still live. Lewiston is also an agricultural area where pesticides are used routinely.
Until my MM diagnosis in 1991 my health had been very good except for a bout with prostate cancer in 1988 found during a TURP. It was diagnosed as stage 1. In August of 1991, I noticed I had lost my stamina so went to my family physician for a check up. My blood work revealed that I had MM (IGG). I had no bone pain at that time, or since.
I began treatment with a local oncologist. Initially, the chemo was BCNU, but after a visit to Fred Hutchinson, to explore an autologous bone marrow transplant (ABMT),I changed to VAD at their suggestion. I had four rounds of VAD after the four rounds of BCNU. I tolerated both protocols without nausea, but had the usual response to Prednisone.
Following are some Lab statistics:
I had an ABMT at the Fred Hutchison Cancer Research Center on 9/18/92. As part of the preparation I had total marrow irradiation. This consisted of two treatments per day for three days. A total of 900 units (whatever they are) was delivered over that time. I did not get nauseous from the treatment. I received both my own purged marrow and peripheral stem cells (not purged) as transplants. I engrafted on day eight and was discharged from the hospital on day 25 to go to my local apartment. Believe I returned home on about day 31.
On returning home I had great difficulty eating solids. I subsisted on milk shakes, instant breakfast, soup and an occasional sandwich for seven months. At that time, literally overnight, I was able to eat anything and have gained 30 pounds since the low point. I had been scheduled to take alpha interferon as maintenance, but gave it up because of the eating difficulty.
I remained in remission for 27 months. After remission I started on interferon to see if it would arrest the MM activity. Although I got up to 10 million units three times a week, it apparently had little or no influence. I remained on it for six months. I then began on Melphalan and Prednisone (June, 1995). It has been effective in lowering the IGG into the normal range, although the dose had to be reduced to half of what would normally be used because of low platelet counts. Last month my Beta 2 was 2.6. I have had no chemo since February 5, 1996.
Aside from the period of eating difficulties after transplant, I have maintained a normal life routine including a cruise, a trip to Israel, and a trip to Europe.
My latest CR lasted 16 months (since 2/96). Because my IGG was again rising I knew further treatment would be needed and sought out what I thought would be the best advice from Dr. Durie. I had an hour long visit. Because I am asymptomatic except for the rising IGG he recommended an MRI or MIBI, a 24 hour urine to check for Bence Jones, and something akin to the labeling index.
If these are all negative I won't begin any treatment until the IGG is at 4,000 or higher. It was at 2,000 last month. Treatment will probably be with M/P again. He had blood taken to check for the newly discovered virus and it was positive.
So far I have had no bone involvement. Dr. Durie said the myeloma is apparently not producing the IL-6 and other cytokines responsible for that. He recommended that I stay on Aredia at 90mg every four weeks as I have for the last year.
Fortunately, my onc/doc is pleased to have any info I bring him and puts it to use as appropriate.
Update 10/12/98: When my IgG reached 3,000 in March of 1998 a BMB was done which revealed a plasma cell level of 58%. It was time for treatment and I chose pulsed Dex with Biaxin. Two treatments lowered the IgG to 700. I later had two additional pulses. On 10/6/98 a BMB showed a plasma cell level of two percent and an IgG of 800.
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