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Ralph D'Errico

Tucson, AZ; emdnurse@earthlink.net

1952 / Class of 2001 / Type: IgG / "Midi"-allo / Remission, GvHD / Last Update: 9/03

(Submitted by his wife)

Ralph was born in Columbus, OH, and grew up in Southern California. He had no known exposures to carcinogens. He was sick as a child with nephritis caused by a strep infection. Though he had a family history of MM in his paternal grandmother, he was healthy and normal most of his life.

He was diagnosed after his chair collapsed at work and he hit the floor directly on tailbone. Back pain got worse and worse with spasms all across his lower abdomen. Doctors thought the injury was merely soft tissue, and ordered aggressive physical therapy, but the pain got worse. Idiot workers'-compensation doctor was incompetent. She was blind to the fact that something wasn't right when Ralph was not responding to her inappropriate back treatment. Completely missed the signs and symptoms of vertebral compression fractures. She told Ralph he was just having "gas."

He ended up with seven compression fractures in the spine. A bone density exam was done and found severe osteoporosis. The cancer diagnosis made seven months after original injury. Ralph was treated by a local oncologist, Dr. Michael Boxer who is a very nice man and very knowledgeable.

Bone damage is his major misery factor. Severe osteoporosis resulted in kyphotic spine. By the time they realized what was causing the problem, the fractures were too "old" to be treated with kyphoplasty, interventional radiology. A huge opportunity missed.

Initial Plasma cells 11%. IgG 3050. Major bone demineralization. He was started immediately on 200 mg. Thalidomide daily and 40mg of Dexamethasone, and stayed on it for six months. Blood levels returned to normal.

He had an allogeneic stem cell transplant (sister was donor match) in August of 2002. Transplant was preceded by 5 days of chemo. Protocol is called the "midi" allo because it is not as harsh as a regular allogeneic transplant, but is more aggressive than the "mini" transplant. The transplant went exceptionally well. Did everything we were told to do. Only problem was nausea and a little vomiting, but symptoms were kept under excellent control. The transplant nurses at the University of Arizona Medical Center were phenomenal.

Nov. 10, 2002: Day 88 post transplant. Ralph has evidence of some graft versus host (GVH) reaction. This is a two edged sword. A little bit is good because you want the donor's stem cells to have an optimal immune response against any remaining Myeloma cells. However, too much GVH can do damage to major organs. Dr. Elliot Epner is monitoring closely (he is an excellent clinician and heck of a nice guy). Ralph feels good, despite blood work that is a bit off. I have confidence that he will get through this just fine. We can't say enough good about the transplant team at University of Arizona Medical Center. They have been great and we have every confidence in them. On Nov. 22. a bone marrow biopsy will be done. Then we'll see......

December 6, 2002: Transplant day + 114. The first post-transplant bone marrow biopsy report is in and shows that Ralph is negative for plasma cells. This means that the disease is in remission! Grade 1 graft versus host disease is present and is affecting the blood, particularly the liver enzymes, but no steroids are warranted yet and the cyclosporine is being adjusted to manage it. Ralph feels just fine. One thing that we so appreciate is the help of a physical therapist who knows how to work with patients with bone demineralization. She is teaching Ralph how to carefully do stretching exercises to help him with the back pain caused by the severe osteoporosis from the Myeloma. It has helped a great deal, though we know it will be a lifelong concern. We are looking forward to the holidays this year. We have come a LONG way since diagnosis (it will be one year Dec. 22). This year we will be celebrating instead of crying. We are so grateful for every day of life.

June 2003: It has now been 10 months since the transplant. Although the Myeloma seems to have abated, we have exchanged that problem for another one: GVHD (graft versus host disease). The doctors were gradually cycling Ralph off his anti-rejection medication, cyclosporine (he received stem cells from his sister in an allogeneic transplant). He was completely off of it for a couple of weeks, but signs of GVHD showed up in force. These included a generalized red, blotchy skin rash all over the body, dry eyes, dry throat with difficulty swallowing, tightness around the mouth, elevated liver enzymes, and nausea. So now he's back on cyclosporine plus prednisone. We are sorry to have to go back on these meds, but he does feel so much better since restarting them.

Ralph went to a pain specialist to see if they could do anything to help with the back pain caused by 7 vertebral compression fractures. The doctor did a lot of tests and offered to try vertebroplasty. This was done on four vertebra T10, T11, L1 and L2. The procedure took about 2.5 hours. He had to lay still and flat for 4-6 hours to be sure the bone cement hardened. They kept him in the hospital overnight. The jury is still out on how much this has helped. Some days the back seems better, other days we're not so sure, but we think overall, it has helped.

We are soon coming up to one year post transplant. In August, a bone marrow biopsy and other tests will be done to see if there is any evidence of Myeloma. We are keeping our fingers crossed. Ralph is home and is able to get out and about. He is able to drive, go to the store, and take short walks. He still tires easily. He is hoping to get back to work as soon as the GVHD gets under control and his back can tolerate sitting at his workstation. This may take a while... We are not sorry we did the transplant. I guess we thought that once we got through that, things would get back to "normal." The road is longer than we thought... BUT Ralph is alive and is looking toward the future.

Keep praying for and supporting those scientists and researchers who are so close to finding out what makes this disease tick.

September 18, 2003: The one-year post-transplant bone marrow biopsy was done on August 16, 2003 and showed no abnormal plasma cells. All other tests indicate that Ralph's Myeloma is in remission. We are so grateful. Ralph is still struggling with the after effects of a donor transplant--graft versus host (GVH) disease. He has a generalized skin rash and very dry and sore mucous membranes affecting the eyes, mouth and throat. He must instill moisturizing eye drops/ointments at least every two hours. Swallowing can be tricky at times and the taste-buds are dulled, affecting appetite. The back pain from previous Myeloma damage to the spine limits many activities. The doctors say that the effects of the GVH may improve, go away for good, go away and come back, or never go away. In other words, they can't predict what will happen in the future. So we cope as best we can and realize that things can always be worse. He remains on cyclosporine and prednisone (anti-GVH drugs) with a tapering schedule. Hopefully, with careful management he can be off all drugs eventually. He has to take lots of prophylactic antibiotics, anti-virals, and anti-fungals. To date, he has not had a serious infection which is GREAT because that is the biggest cause of problems with transplants. He is diligent with his care and follows directions to the letter. It has paid off. The one positive aspect of GVH, (annoying as it is) is that it keeps the immune system alert to clandestine Myeloma cells and continues it's "search and destroy" mission should any of those bad cells still be lingering in Ralph's body. So, I guess every cloud does have a silver lining.

The days after we were told of the diagnosis were dark indeed. It was Christmas time and we cried all the way from Christmas to New Years and beyond. But there comes a point when you have to stop crying and learn to live with cancer. God knows our needs. He has sustained us and will continue to do so. There is hope, and there WILL be a cure. At the very least this disease will be controllable like any other chronic illness such as diabetes or heart disease. Pray daily for all the scientists and researchers who are working so hard on conquering this disease. Donate to the Multiple Myeloma Research Foundation. Participate in clinical trials. We will overcome this malady. Don't despair. Each day is a gift. Cherish it.

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