Frequently Asked Questions:

http://myeloma.org/ArticlePage.action?articleId=3245

Follow Up Statement from Support Group Leader Conference Call on Second Primary Cancers and myeloma treatment:

http://myeloma.org/ArticlePage.action?tabId=0&menuId=0&articleId=3247&aTab=-1

My husband Michael and I discussed the ASH studies and above articles at length. Of course, just like all of you, we are concerned about any issues on myeloma treatment. 

Michael is an 11-year myeloma survivor, diagnosed in 2000 at the age of 36. He was fortunate enough to be diagnosed with myeloma at the best possible time. Sound crazy? Well, when you look at what treatment options were available prior to 2000 and that statistics were showing average 3-5 year survival rates; compared to what treatment options are currently available, where we are looking at much longer average survival rates and better quality of life...well, yes, that's positive progress!

Our feelings are that we need to be "patient" patients. Based on the IMF's teleconference for support group leaders in which we took part, it was clear that Dr. Durie, Dr. Anderson and all the International Myeloma Working Group's scientific advisors are hard at work gathering additional data. We cannot and should not jump to conclusions and change our treatment plans until we have clear data. Clinical trials are set up to gather particular information in each phase of the trial. Post-trial data has not been tracked in the past. As patients live longer because of new treatments being approved which give us better quality of life, longer remissions and overall survival, trials are also pointing to other aspects we need to pay attention to and learn from. That is what the experts are doing now.

This is all good news for myeloma patients!  We are living longer and learning what treatments are the best options with the least side effects. As corny as it may sound, I totally go back to the IMF's motto of "Knowledge is Power." The more we learn the better off we will all be. So let's try our best to be "patient" patients and caregivers. Talk to your myeloma expert, read the IMF website for updates and trust that the scientific advisors are reviewing all the data feverishly and thoroughly on behalf of us all.

Let me end with Michael's primary thought:  "When I relapsed in 2005, Revlimid was in the Expanded Access Phase of the clinical trial. My myeloma expert, Dr. Ruben Niesvizky at Weill Cornell Medical College, Robin, and I discussed all available options at that time. There is no doubt in my mind that Revlimid was my best option. I have enjoyed the last 6 years in complete remission and a good quality of life. Who knows where I would be today if I did not go on Revlimid. Of course, I will keep a close watch to see what the experts learn and advise."

**UPDATE/HOT OFF THE PRESS:  Today (Thursday) we woke up to 18 more inches of snow here in Connecticut.  As beautiful as it is outside, it's also time to be smart and take extra safety precautions.  This last storm brought very heavy/wet snow so shoveling can be dangerous.  Please remember that if you absolutely HAVE to shovel please take breaks and pay attention to your breathing.  It's very cold outside too, so dress appropriately.  Even a trip out to the mailbox can be a big deal!  A slip and fall for a myeloma patient is never a good thing!

Check your prescriptions, if you are going to run out, call the pharmacy to reorder and ask if they can deliver it to you.  If you don't need to go out and drive, then stay in and be safe!

Now's absolutely the time to ask for a little help.  Please be careful.

Since I live in New England, I thought I would write a timely blog about the snowy winter we've been having and how patients and caregivers deal with it.   

I was born in Connecticut and fondly remember playing outside in the snow, rolling different size snowballs into giant snowmen, snowwomen and even snow doggies!  Making snowforts and having the best snowball fights and, of course, making the perfect snow angel without getting your handprint in the snow when getting up!  

Sliding in my parents' backyard was a neighborhood favorite.  We started in my yard and slid through two neighbors' yards and then finally (if you so dared) through the woods down "killer hill."   By the time we walked back up to the top to slide down again, it was time for a cup of hot cocoa!  What great memories!  If you are going to live in New England, then you'd better love the snow!

Today, while I still love living in New England and enjoying all four seasons, the winter does bring with it some challenges.  Mother Nature gave us a foot of snow right after Christmas, then another two feet last week, and today we are forecast to get 10 more inches!  As a caregiver, I know this can add to our responsibilities and worries.

 Are you able to drive your loved one/patient to their doctor's appointments?  Physical Therapy?  Pharmacy?  Grocery store? (The list goes on) . . .If you don't have front-wheel drive or better yet, four-wheel drive, this can be a bit tricky!  Here are a few ideas that may be helpful:     

• Some cancer centers have volunteer drivers you can contact to arrange rides to/from the doctor's appointment. Call your local cancer center and ask!
•  Some towns have a "Senior Bus." Call your Town Hall and ask if they can drive you to the doctors, therapists, pharmacy, grocery store.
• Small "mom & pop" type pharmacies still offer delivery service. Check with them!
• High school students need to fulfill a certain amount of community service hours to graduate. Call your local high schools and find out if there are responsible teenagers in your neighborhood that can help you. 
• Other possible volunteers who may be able to help: Eagle Scouts, church members, neighbors and, of course, family and friends.
• Shoveling! Need I say more? If you don't have someone plowing your driveway this year, find someone now! Slipping and falling if you are a myeloma patient is just not a good thing. If you've got kids in your neighborhood, ask them! They'd love to make a little spending money . . . or better yet, perhaps even save a bit for college!

Neighborly help is always welcome.  Thanks, Chris!

You may find that people are always asking you "what can I do to help?"  Well, now may be the time to let them know.  It makes people feel good to help and it will lighten your load a bit, too!

During the last snowstorm we had, our neighbor's son-in-law stopped by to snowblow his driveway.  He saw Michael, me and our two children shoveling our driveway, and before we knew it - he was helping us too!  (Thanks, Chris!) Thanks, also, to our neighbor Gary for plowing out the end of the driveway all winter! 

Do you have some tips for dealing with the winter weather to share?   Please consider posting them here under "comments." We'd love to hear from you!

A very dear and respected friend and caregiver, Ray Uzanas, e-mailed me with a comment in response to my blog post from December 22, 2010 entitled "10 Steps to Avoid Caregiver Burnout in 2011."

He wanted to elaborate my point #10: "Honor the work you're doing."  

Ray was the caregiver to his wife Loretta for 12 years.  Loretta was diagnosed with multiple myeloma in 1992.  A later breast cancer diagnosis and ensuing treatments further detracted from her quality of life.  Ray refers to Loretta's stamina as "Herculean," but as a caregiver, I'm sure Ray's efforts were equally courageous.

My hat's off to Ray and all caregivers for the love, patience, dedication and hope they display each and every day. Ray has also written a book entitled "Odyssey of a Wayward Traveler," which began a journey of self-discovery, renewal and adventure.     
Here is Ray's take on "Honoring the work you do":

As survival time for MM increases, so does the care-giving period, and this is both a blessing and challenge to caregivers and their loved ones. Despite their faithful support and love, caregivers' resolve can be tested often as the years pass. The altered lifestyle can take its toll on the most well-intentioned of caregivers.

During my 12 years as a caregiver to my wife Loretta, at times of particular stress, I would draw strength and purpose in the knowledge that I was given another calling, another challenge, another path to follow in life that would permit further character development; new and meaningful ways of expressing my love to another person; and finally, by the very nature of my behavior, set an example worthy of being passed to family, friends and others.  

We, as caregivers, never asked for that role, just as those diagnosed with MM never asked for their disease. I think it's how we "play the hands we're dealt" during our lives that can define our legacy.

Thanks, Ray, for your insight into the caregiver experience!  I'd love to hear from other voices out there how you deal with challenges we all face sometimes.

If you're a caregiver, I'm sure one of your main concerns is learning about the latest and greatest in the myeloma research/treatment world.  Interpreting all of this information can be a challenge.
In one of my first posts on this blog I talked about what I look for when reviewing research information from the American Society of Hematology (ASH).

Today, I'm going to introduce you to someone who does a really good job of understanding the data.

Years ago, Michael and I attended the annual meeting of ASH with another myeloma patient and good friend, Jack Aiello.  Jack was diagnosed with multiple myeloma in January of 1995. Yes, you read correctly, 1995, which means he is a 16-year survivor.
We also had the opportunity to attend ASH again this year in Orlando, Florida with Jack.  His perspective on these meetings is fresh and "patient friendly," and Jack is allowing me to share with you his thoughts.

Myeloma Highlights from ASH According to Jack (definitely not medically trained)
This is the fifth year I've attended ASH. I typically focus on the Clinical Trials, which I'm able to understand and are more relevant near-term to patients

During the last couple of years at ASH there have been many reports on response rates to combination therapies, which typically include the novel drugs Revlimid, Velcade, and/or Thalidomide; the effectiveness dosage reductions; whether maintenance treatment might increase overall survival; and, of course, the results of new drug therapy.
This year provided more encouraging data results for many of these regimens. Last year was the first time I'd ever heard 100% ORR* response rate for newly diagnosed patients in a trial with RVd.  And this year I heard it twice in trials with VdC-mod and CfzRd. Maintenance treatment with or without a preceding transplant using lower doses of Revlimid, Velcade or Thalidomide all improve PFS, but it's too soon to know if OS is extended.
Some transplants regimens show seven-year median survival rates and are considered a treatment option for transplant eligible patients.  Will novel therapy treatment surpass transplant efficacy?  It's just too soon to tell.

A Few Comments I Found Provocative

• A panel of experts was asked "How important is CR for a non-transplant patient"?  Answers "Important for OS"-D. Roodman; "Yes, but be mindful of toxicities"-N.Raje; "The goal is to always get the best possible response"- J. Kaufman; "We see durable PR's." C. Farber. An observational trial Vd vs V-only showed better responses for Vd but similar TTP & OS. [Sun-3027]

• If PET-CT scan shows spine lesion, should follow with an MRI to further quantify." S. Jagannath
• "Although maintenance has shown longer PFS, we cannot change the OS metric as a means to validate treatment." S. Rajkumar; "Maintenance therapy is effective and likely to be with us for a long time." G Morgan

• "For relapsed MM patients, I look at Disease-related (e.g. response duration, cytogentics), Regimen-related (e.g. prior drug experience, dosage mode) and Patient-related (e.g. pre-existing toxicities such as PN, age) factors before determining next treatment." For example, using current drugs, if patient's MM is indolent, slow and first relapse, I'll suggest Rev if initial tx was Velcade & visa-versa, or a transplant if at least 18-24 mos remission from prior transplant.  If the patient's MM is aggressive, rapid and has had several relapses, I'll suggest DCEP or DTPACE chemos or VR combo's or perhaps a transplant, which can give quick control but is likely to have a short-lived response." S. Lonial

• At ASH2010 there are 300 abstracts on new MM drugs and combination therapies, including IMIDs: Pomalidomide; Protesome Inhibitors: Carfilzomib, CEP18770, NPI-0052; HDAC Inhibitors:Panobinostat, Vorinostat, Tubacin; PI3K/Akt Pathway inhibitor: Perifosine; KSP Inhibitor: ARRY-520; CDK4/6 Inhibitor: PD 0332991; mTOR Inhibitors: Temsirolimus, RAD001; Monoclonal Antibodies: Elotuzumab, CNTO328, Milatuzumab. S. Lonial

• "Carfilzomib is incredible." D. Siegel  [Onyx hopes to go to FDA summer 2011 for approval.] Both Onyx and Millennium are working on oral versions of proteasome inhibitors.

• "The 5-yr PFS is 100% for R consolidation and maintenance so I'm beginning to think some of these pts might be cured." M. Attal

• New IFM/DCFI 2009 study: RVd*3, hvst, SCT, RVd*2, Rx18 mos vsRVd*3, hvst, RVd*5, Rx18mos (SCT@relapse).

• When one of the Pomalidomide studies showed Pom given 21 of 28 days worked as well as 28 of 28, a question from the audience asked "Why not 14 of 28?"

*For a definition of acronyms go to this glossary.

Thanks, Jack!

To hear direct clinical trial updates from the investigators go to the IMF website and click on webcasts www.myeloma.org.  And don't forget that on Thursday, Jan. 13, the IMF presents a teleconference, "Best of ASH - What Myeloma Patients Need to Know," with Dr. Brian Durie and featuring a Q&A.

Recently, Brynn Mandel of the Waterbury Republican-American newspaper in Connecticut contacted me for an interview about this blog.  

Well, on Saturday the newspaper ran a teaser pixture that an article would be in the Sunday Edition/Health Section.  The next morning, when I opened up the Sunday paper - bam - there was a picture of our family and a great article!

Here's a teaser. You can find the entire article by clicking on the link below.  Thanks, Brynn!

Couple turns devastating diagnosis into vehicle of hope

BY BRYNN MANDEL |REPUBLICAN-AMERICAN

They are a family that turned a devastating diagnosis into a mission, and now their work -- which has brought them from the halls of Congress to an RV that they steered through a swath of the country to raise awareness -- will extend to the virtual world.

During this hectic holiday season, I'd like to share with you some tidbits I've learned along the way as a caregiver.  I love Michael with all my heart, and if you have a spouse who has been diagnosed with myeloma, I'm sure you feel the same way - you want to do everything you can to help him or her.

I'll start with a story: A teacher holds up a glass of water and asks his class how heavy it is. After they guess, he explains it's not absolute weight that matters, but how long you have to carry it. A few minutes is easy, but if it's every day for months, sooner or later the burden will become unbearable--you'll have to put it down and recharge before you can pick it up again.

 Here are a few suggestions:

1.  Realize that you are the caregiver.  Although you want to do everything you can to help, you don't want to take away a person's dignity or make choices for them.  You are there to help them and work together as a team.  Let them do what they can and offer help when needed.

2.  Learn about myeloma advances.   Knowledge is Power.  When my husband was first diagnosed ten years ago, the greatest anxiety was fear of the unknown.  Once I started learning all I could from reliable sources--treatment options, side effects, clinical trials, quality of life issues--I started to feel empowered, more in control of myself as well as Michael's treatment plan.

3.  Become a pro at organization. Keep a binder with all medical records and take notes when you go to the doctors.  You may even want to bring a tape recorder, just ask the doc first if he's ok with that.  If you are good on the computer, you can download the IMF's free  Myeloma Manager, personal care assistant.  At its core, the Myeloma Manager provides a tool to capture lab results and display and print tables and charts to show how those results change over time.  The site features a webinar on how to use this.

4.  Prioritize.   Job #1 is taking care of the patient, yourself and your family; dirty laundry and dust bunnies are not. Put on blinders, and simplify your life.   

5.  Resist doing everything yourself.  Determine what's unique to your position as caregiver, and what you can delegate. If the patient is your spouse, save your energy for when he/she wakes up terrified or sick in middle of the night--that's support no one else can provide.   Call a family-and-friends meeting and explain how they can help; post a volunteers' schedule they can access online like Lotsa Helping Hands or CaringBridge.  CaringBridge helps you stay connected with loved ones during a serious health event.

6.  Recharge your batteries. Make time for yourself to maintain a fresh, optimistic outlook.  You also need to take care of yourself.  When you get on a plane, what are the instructions the steward gives you? . . . To put your mask on first  . . . right?

7.  Create a multi-layered emotional support network.  Talking relieves worry and stress.  If you attend a myeloma support group with your spouse, that's great; but are you able to discuss your concerns as a caregiver?  At our myeloma support group in Connecticut, I hold a special breakout meeting just for caregivers at least once a year.   If you don't go to a support group (which I highly recommend) then perhaps you can create a blog or use the ACOR listserv , a great sounding board when you're up at 2 a.m. looking for answers.

8.  Acknowledge your feelings. Caregivers often bury their emotions or feel guilty for having them. One of the hardest to voice is needing a break from caregiving. The last thing you may want to say is "no," but at times it may be necessary--"No, I can't drive you to the doctor's today, but Sam will."  And that's OK.

9.  Check yourself for signs of depression.  These include sleep problems, significant changes in weight, and more frequent illnesses. You may be so focused on taking care of the patient you don't notice that your clothes don't fit or aren't concerned about the lack of sleep.

10.  Honor the work you're doing.   Caregiver is the ultimate rewarding job because you do it out of love.  Realize that what you're doing really matters in life.

Do you have any more tips for caregivers?  I would love to hear from you about them!  Meanwhile, I'd like to wish everyone a Happy, Healthy, Peaceful Holiday and New Year!

I promised to tell you about a serendipitous meeting at the ASH meeting in Orlando in my first post. In August of 2000, when Michael was going through his initial testing for multiple myeloma at New York Presbyterian Hospital/Cornell University, his first bone marrow biopsy was performed by a young doctor, who was just a fellow at the time, Dr. Hearn Jay Cho.

Unfortunately, the results of the biopsy confirmed that Michael had myeloma. He had just turned 36. Dr. Cho gave us the diagnosis and we talked about what myeloma is and what options were available.

I'm sure you remember the day (like in slow motion) when you or your loved one was diagnosed with myeloma and the initial fear and anxiety crushing down on your life. I see newly diagnosed people at our support group and they have that "deer in the headlights" kind of look on their face.  

But as time goes by, we learn that fear does not help us.  We need to learn as much as we can and to be proactive in this fight against the beast called myeloma.

During the 10 years since Michael's diagnosis, Dr. Cho moved to NYU Cancer Institute, where he is Assistant Professor of Medicine and Pathology.


During those same 10 years, Michael had a stem cell transplant (2002) no maintenance, surgery (2004), relapse (2005) and went on the expanded access program of Rev/Dex and is currently on Rev (10 mg) and low dose dex.  I'm thrilled to report that he is still enjoying complete remission and a great quality of life!  While the MM has had tough side effects with bone involvement and he can't do things like he used to . . . he's able to carefully coach our son's little league baseball team and basketball team.  The kids know about the myeloma and joke that if they make Mr. Tuohy chase a ball they'll have to do laps!  LOL!

Cut to the ASH meeting in Orlando: Our paths were about to cross again. Michael and I attended the IMF's Junior and Senior Grant Awards presentation, and there to receive an award was Dr. Hearn Cho!  It was one of the highlights of our attending ASH to learn that this young doctor committed himself to stay in the myeloma field and is conducting research to help our futures! (Next to him in the photo below is Tricia Nardiello, a PhD student who works in Dr. Cho's Lab.  She gave a talk at ASH on the MAGE-A3 project.)

After the awards ceremony we talked to Dr. Cho about myeloma . . . but we talked more about life! We talked about our children and music.  It was so much fun to hear Dr. Cho and Michael talking about rock-and-roll and what concerts they'd recently seen and that his son plays the drums and ours plays the bass and our daughter plays piano!  Maybe they'll have a band together someday, who knows?

Dr. Cho is one of many beneficiaries of the IMF's research grant program, which funds promising clinical investigators around the world in an effort to improve outcomes for myeloma patients.  He is looking at a class of drugs called "anti-folates," which have been used for other types of cancer, but not myeloma.

"There is a new anti-folate called pralatrexate," Dr. Cho told me in an interview after the conference, "and we have discovered that many myeloma cells are susceptible to this drug.  In resistant cells, we have identified at least two genes that may help the cells escape the killing effect of pralatrexate.  Therefore, if we can find other medicines that can change the expression of these two genes, we can convert resistant cells into sensitive cells.

"These other medicines don't necessarily have to kill myeloma cells, but combining them with pralatrexate could be a potent new method for treating myeloma.  Our goal is to have clinical trials of these 'rationally designed' pralatrexate therapies within the next two years."

I also asked Dr. Cho what he felt are the most promising clinical trials in each of the newly dx, relapse and relapse/refractory settings?

"I think everyone in the myeloma field is excited about the recent results with combinations of Revlimid, Velcade, and dexamethasone for newly diagnosed multiple myeloma," he said.  "We need to be cautious, though, because we do not know yet if the higher up front response rates will translate into longer survival for patients.  We hope so, but it is not known, yet.  Pomalidomide and Carfilzomib are two drugs that are in late stage clinical trials that we are eager to get into regular clinical practice soon."

Dr. Cho said that the clinical trial he is very excited about "is based on the other project in my laboratory.  We are opening a multi-institutional trial in 2011 of a vaccine targeting a protein called MAGE-A3, which is expressed in many patients' myeloma cells.  We are adding the vaccine to auto-transplant, in order to stimulate an immune response against MAGE-A3 that will help each patient's own immune system find and kill remaining myeloma cells."

The trial is sponsored by the Ludwig Institute for Cancer Research with financial and logistic support of Glaxo Smith-Kline.  NYU Cancer Institute is the lead institution, along with partner institutions Memorial Sloan-Kettering Cancer Center and Fox Chase Cancer Center.

Dr. Cho sounded very hopeful about the progress being made on the myeloma front. Hope is good. As Henry James wrote in "The Beast in the Forest," don't let the fear of the beast ruin your life.  Go out today and make some fun and create beautiful memories!

If you've got a fond memory you'd like to share - send me your comment!  We all need to hear about life outside of myeloma too!  

For the next few days I'll look at a few of the studies presented at the ASH (American Society of Hematology) 2010 annual meeting from a caregiver's point of view. I'll try to boil the complicated findings about myeloma treatment down to a few key points.

What's really exciting is to be sitting in on the ASH panels, as Michael and I were, and hearing nuggets of hope.  Case in point was when Dr. Michel Attal of the Hopital Purpan in Toulouse, France, lead investigator in a study of Revlimid maintenance after stem cell transplantation said, during a Q&A: "I'm convinced some of these patients will be cured."

Today, let's look at Revlimid in the maintenance setting and continuous treatment.

#1 Revlimid Maintenance After Stem Cell Transplantation (CALGB 100104 Study)

In the first study, 568 multiple myeloma patients under the age of 70 years were randomized to receive either Revlimid maintenance therapy or a placebo following autologous stem cell transplantation.

A preliminary data analysis from this study in 2009 showed such a significant improvement in the time to disease progression in the Revlimid maintenance arm that the study was unblinded, and patients in the placebo arm were allowed to switch over to the Revlimid maintenance arm.

The 18-month follow-up results were presented by lead investigator Dr. Philip McCarthy of the Roswell Park Cancer Institute in Buffalo, New York. The results showed that patients who received Revlimid exhibited a median time to disease progression of 42 months compared to 22 months for patients who received the placebo. Overall survival was similar for the two groups. Dr. McCarthy explained that this may be due to the significant percentage of placebo patients who switched over to Revlimid maintenance when the trial was unblinded in late 2009.

#2 Revlimid Maintenance After Stem Cell Transplantation (IFM Study)
One of the most exciting things to come out of this presentation was confirmation of what I wrote about in my first blog post: the importance to patients and caregivers of Quality of Life.

Here, 614 multiple myeloma patients under the age of 65 years who had recently undergone stem cell transplantation received consolidation therapy with Revlimid, and then were randomized to receive long-term Revlimid maintenance therapy or a placebo.

A preliminary data analysis in late 2009 showed that Revlimid maintenance significantly improved progression-free survival. Therefore, this trial was also unblinded in mid-2010, and patients who were originally in the placebo group began receiving the Revlimid treatment regimen.

Dr. Attal, lead investigator of the study, presented results based on data that was collected up until the unblinding of the study. The results showed that Revlimid consolidation therapy improved responses and progression-free survival compared to transplantation alone. Revlimid maintenance therapy, however, did not significantly increase the number of patients who achieved a complete response.

When the study was unblinded, it was estimated that four years after diagnosis 60% of patients who received Revlimid maintenance would still be alive without disease progression compared to 33% for patients who received the placebo.

This benefit was observed even if patients achieved a complete response after induction therapy, showing the importance of maintenance even if a patient achieves a good response after initial treatment.

Dr. Attal commented that a longer follow-up study was needed to appreciate the impact on overall survival. However, he said that the better progression free survival is a huge improvement in Quality of Life. 

#3 Revlimid Maintenance In Newly Diagnosed, Older Myeloma Patients

Dr. Antonio Palumbo from the University of Torino in Italy investigated the addition of Revlimid to melphalan and prednisone in elderly newly diagnosed myeloma patients.

The study included 459 patients ages 65 years and older who received one of three possible treatment regimens. One regimen consisted of nine 28-day cycles of melphalan and prednisone alone, followed by placebo (MP). The second regimen consisted of nine 28-day cycles of melphalan, prednisone, and Revlimid, also followed by placebo (MPR). The third regimen was the same as the second, but, instead of receiving placebo after the first nine cycles of treatment, patients received maintenance therapy with Revlimid (MPR-R).

Dr. Palumbo and his colleagues found that responses were more rapid and better with MPR-R than MP, with a median onset of response of 2 and 3 months, respectively, and overall response rates of 70% and 50%, respectively.

A comparison of the different regimens showed that the Revlimid maintenance regimen, MPR-R, had a longer progression-free survival than the other two regimens. Progression-free survival for MPR-R, MPR, and MP were 31, 14, and 13 months, respectively. These results show a clear benefit to Revlimid maintenance therapy but have caused some physicians to doubt the advantage of using Revlimid upfront in elderly patients.

Side effects of MPR-R were manageable, but a larger percentage of patients on that regimen discontinued therapy due to side effects as compared to patients on MP. The most common severe side effects were low blood cell counts that occurred during the MPR phase of treatment.

That's enough for today. Hope this info was helpful and interesting to you. Remember the IMF's motto, Knowledge is Power. The more we learn the better we'll be able to make treatment decisions along with our doctors.

I don't know about you, but I'm very excited with the results coming out of all of these trials and will certainly look forward to updated information to come.