The Waiting Game

The Waiting Game

Facing down an incurable cancer with optimism and research

In late November of 2006, the pain in Bill Herlihy’s back had become unbearable. At 56, he knew he was at an age when a lot of men suffer regular back problems, but the pain he’d begun experiencing months before had escalated beyond what could be considered normal.

Herlihy sought help at a pain management clinic. There he discovered the awful truth. His spine was fracturing.

“There were stress fractures in 12 or 13 vertebrae and the pelvis,” Herlihy says.

Over the next two months, Herlihy would spend 38 days hospitalized during three separate stays. He came close to dying of renal failure and says, “It’s almost a miracle to be alive today.”

Herlihy suffers from a rare blood cancer known as multiple myeloma. Myeloma makes up only about 1 percent of cancers, but it is the second most prevalent blood cancer after lymphoma.

Doctors do not understand what causes multiple myeloma, but they do know that it begins when plasma cells, a type of white blood cell in the bone marrow, mutate and begin to reproduce themselves.

“As they grow, they take over space in the bone marrow,” explains Dr. Cara Rosenbaum, an Assistant Professor of Medicine, specializing in multiple myeloma, at the University of Chicago Medical Center (U of C), and Herlihy’s doctor.

The reproducing cancer cells repress the normal, healthy cells, further compromising the immune system. Plasma cells make protein antibodies that fight bacterial diseases and other infectious illnesses. A healthy person has an array of antibodies comprising a powerful defense. But measure the antibodies of a person with multiple myeloma and you’ll find that the cancerous cells are reproducing one antibody over and over.

“This causes high levels of protein in the blood and often, high levels of protein filtered by the kidney, which can lead to kidney failure,” Rosenbaum explains.

Eighty percent of people stricken with multiple myeloma will at some point have bone complications from their disease. “Large lesions that can eat away at bone causing loss of bone strength and fractures,” are common, Rosenbaum says.

Herlihy’s spine fractures deformed his back. He lost six inches of height, compressing his major organs like lungs and intestines, causing difficulties with breathing and digestion.

“I came home from the hospital; I couldn’t walk on my own; I had to use a walker. My wife had to bathe me, dress me, everything. It was a tough time,” Herlihy says.

After battling the existing cancer growing in his bones, doctors at the U of C performed an autologous stem cell transplant in December of 2007, which finally put Herlihy’s cancer into remission.

In an autologous transplant, stem cells (undifferentiated cells capable of becoming any type of cell the body needs) are collected from the patient’s own peripheral blood and transplanted to the site of the cancer. This is done after the malignancy has been largely destroyed through treatments like chemotherapy.

“Therapies available in the past have not been curative,” says Rosenbaum. Receiving high doses of chemotherapy and a stem cell transplant can help to extend the time before the cancer returns. But in the case of multiple myeloma, it will usually return at some point.

“Somewhere along the line, I became resolved to the fact that cancer will probably get the best of me someday and accept it, as much as a person who doesn’t want to die can, accept it. I have accepted it,” Herlihy says.

Herlihy’s acceptance of his situation is perhaps a healthy attitude, but for Rosenbaum and other doctors and researchers, acceptance doesn’t enter the vocabulary.

“We have a host of new drugs that are very promising for [the treatment of] multiple myeloma,” says Rosenbaum. “We are seeing unprecedented responses to these new drugs, especially in combination. We hope that will translate into longer survival and eventual cures in this disease.”

If effective enough, newer therapies might eliminate the need for a transplant in many cases. Time will tell; it will take another two or three years for data to be conclusive. Researchers remain hopeful.

For Herlihy, now in his sixth year with cancer and fifth year in remission, daily life remains a struggle. But he doesn’t hesitate to point out that he feels lucky to be alive. “My oncologist just told me this year that he never expected me to leave the hospital,” Herlihy says. But leave the hospital he did. And with the potential promise of more effective treatments, Herlihy and his doctors are not done fighting.