By Linda Scherer
Ken Kremer, retired Winsted pharmacist, showed an amazingly cheerful attitude as he worked to get his paint sprayer unclogged and ready to put a fresh coat of paint on the outside doors of his home.
He was enjoying every minute of the sunshine and fresh air, with a long list of things to do, because the next day he was to have chemotherapy in preparation for a stem cell transplant.
Kremer was diagnosed with myeloma, a cancer of the bone marrow, Aug. 24, 2006. It is not bone cancer, although it affects the bones. There is no cure for myeloma, and it cannot be put into remission. However, it can be suppressed.
As part of Kremer’s treatment, he is to undergo an adult stem cell transplant sometime this year, which, in similar cases, has been very successful in treating this type of cancer.
While some might be a little apprehensive about this procedure, Kremer has put his faith in God, which has been constant throughout his illness. He believes that everything happens for a reason. Also, his pharmaceutical background has given him an understanding of how the treatment is to work and that knowledge is encouraging to him.
“It wasn’t that long ago that we didn’t even have stem cell transplants,” Kremer said. “They have been doing this for about 40 years, but it was pretty experimental until about 15 years ago.”
“I can lead a somewhat normal life and enjoy life while going through this,” Kremer said. “If this had been 50 years ago, I may very well have been dead by now. And my prognosis is good, too, for another five to 10 years.”
More than a year ago, Kremer began showing symptoms of the myeloma. He had been seeing a doctor for arthritis, when he was told that he had slightly elevated monoclonal protein levels, which could be an indicator of myeloma. By June 2006, both he and his wife, Evonne, knew something was wrong.
“My hemoglobin was dropping,” Ken said. “As soon as my rheumatologist saw that, he immediately referred me to Dr. Menge, an oncologist at the Park Nicollet Clinic in St. Louis Park.
“We didn’t know what was happening. I was unusually tired, sleeping 10 to 12 hours, and taking two or three naps a day. As long as I had to be alert, I was fine, but as soon as I didn’t have to concentrate, I would be asleep.”
Ken’s oncologist did some blood work, a bone marrow biopsy, and took x-rays of his entire body a total of 22 x-rays.
“They start with an x-ray of your legs and just work their way up,” Ken said. “One of the things that myeloma does as it gets more severe is makes little pin holes in the bones because it destroys the inner lining and then starts to work on the bone. X-ray is one of the measurements that shows the extent of the myeloma, where it is and how severe it is. They found that 40 percent of my bone marrow had myeloma and 60 percent did not.”
An interview was set up at the University of Minnesota, where all of Ken’s health information was sent. He was interviewed for about an hour to see if he was a good candidate for a stem cell transplant.
“They suggested stem cell transplant right away, partly because of my age,” Ken said. “They will not do a stem cell on anyone over 70. Myeloma is primarily an older adult’s disease. The average age is 55 to 75. My general health was good and at 60 years of age, I am a very good candidate.”
The university contacted Ken’s insurance company and explained what it had found and what it thought needed to happen. A case manager was assigned and looked at the criteria to see if Ken was covered. His insurance did agree to cover the transplant.
Stem cell transplants have a good history with leukemia and myeloma
Ken will be his own stem cell donor. Adult stem cells can also come from a sibling, or from an anonymous donor. Because Ken is using his own stem cells, there is little chance of developing graft versus host disease, which is caused by a reaction to somebody else’s stem cells.
There are two other stem cell categories: embryonic stem cells, and cord blood stem cells, found in the umbilical cord.
In a normal transplant situation, when everything works the way it is supposed to, the first step would be to suppress the cancer with chemotherapy. Then, the entire transplant process would be done at one time.
“They knock the cancer down, build your system back up, extract the stem cells, and as soon as they give your body a rest for a few days, they give you another big massive round of chemo,” Ken said. “It is just a single dose, but it is a massive dose. A few days later they would give you your stem cells back.
“The entire process takes about a month to six weeks,” Ken said. “You would be down at the university for at least another 30 days until your system has picked up those stem cells and started to reproduce them. The white blood cells are the most important because that is the body’s defense.”
Ken’s case has not turned out to be quite as simple. There have been complications and a few setbacks.
A condition called vasculitis, which is an inflammation of the blood vessels, caused Ken to take low doses of prednisone for a long period of time. The prednisone is used as an anti-inflammatory drug. Doctors are concerned because it is also used as an immune suppressant as part of the chemo treatment and it might not work as well since Ken has used it in the past.
Ken’s first setback came after his first chemotherapy in September of last year, when it ended with an allergic reaction to one of the medications, which required time for him to recover.
In December, another round of chemotherapy was given and that suppressed the myeloma some, but then the medication lost its effectiveness.
At that point Dr. Mark Menge at Park Nicollet and Dr. Marcy Tomblyn at the University of Minnesota’s Transplant Center decided that Ken’s stem cells should be removed after another round of chemo and held in storage until they were able to suppress the myeloma to the level they felt would be the smallest percentage possible.
“If they don’t suppress this down to a very small percentage, then the cancer will come back too fast,” Ken said.
“By removing the stem cells and storing them, it allows the doctors to do chemotherapy using a broader spectrum of medications,” Ken said. “This is because there are certain drugs that cannot be given to the patient until after the stem cells are removed because they alter stem cells, making them impossible to be used in a transplant.”
It was the end of March when the stem cell draw was done.
Ken had chemotherapy in the middle of May and another round of chemo the middle of June. Ken’s myeloma continues to be monitored so as soon as it is suppressed low enough, doctors can perform the stem cell transplant.
“Doctors at the university said it would be at least three rounds of chemo,” Ken said. “I would rather have one more treatment after this one than be just on the edge of OK. I would rather have an extra treatment and push it beyond. What is five weeks? We are coming up on a year now.”
The chemotherapy is a five-week regime. It is a cocktail of four different chemo drugs, an anti-inflammatory drug, and a growth hormone to stimulate the system to bring the blood count back to normal faster.
“It takes about two to three weeks to start feeling better after the chemo,” Ken said. “The first 10 days or so you don’t feel like doing much. The nausea drugs help a lot, but they make you very tired.”
Even with his upcoming chemo treatment, Ken remains optimistic.
“Leukemia and myeloma have had a good history of stem cell transplants working,” Ken said. “Some have survived more than 10 years. I think that we can be very thankful that we have people with this knowledge and this ability.”