Waldenstrom's Macroglobulinemia: My story

By Steve Kirsch
Originally written: August 11, 2007
Updated Jan 1, 2015

Abstract

In July 2007, I was diagnosed with a rare incurable blood cancer.

This page describes what happened after I was diagnosed and what I did to try to save my life and the lives of others with this disease.

The most important thing you should know is this: if you invest the time to think through the treatment options, you'll find there are lots of treatment options with very little side effects that will keep your cancer "at bay" for a long time.

I learned that there are a lot of opinions out there as to how WM should be treated. There are no "right" answers: everyone responds differently to identical treatment protocols. I asked 3 WM experts how I should be treated upon diagnosis and I got 3 completely different answers: Rituxan solo, Rituxan/Velcade, Cytoxan-Prednisone-Rituxan. So there are just personal tradeoffs of the different options available to you. There is no optimal solution or "right" answer. There are only alternatives, each with pros and cons. You can go with an aggressive treatment that might give you a complete remission, but it also might fail and leave you with permanently depressed blood counts regardless of whether it fails or succeeds. Other treatments might cure you or lead to transformation to a more aggressive cancer. The three treatments originally suggested to me are all relatively safe, although the Cytoxan can lower your blood counts, and the Velcade can give you peripheral neuropathy. I never tried Velcade and never intend to because there are other drugs with similar effect that do not cause peripheral neuropathy. Sadly, Velcade still gets prescribed.

I've complied a list of the latest (as of 2015) drugs at Waldenstrom's macroglobulinemia: Drug options. You should check these out and discuss with your doctor.

Joining the IWMF talklist is the single most important thing you can do to become better educated about the disease and treatment options. The second most important thing is learning about what clinical trials people are on and how they are working and whether you can get in one of them. You can get this from the talklist.

WM affects different people differently. Some people aren't affected much at all. Others have lost their eyesight and hearing and then their lives due to the disease. But those cases are really rare. Sometimes, the treatments lead to problems that are worse than the disease. Death is pretty rare. Most people who get WM usually end up dying from something other than WM (but that other thing could be caused by the treatment).  The old saying goes, "You are more likely to die with WM than from WM." Probably true, but unfortunately it's not so unrelated...the WM treatments can cause problems that you die from. So it's not really so comforting.

I tried the conventional treatments (the chemo), then quickly went into clinical trials. This wasn't because I failed the conventional treatments. It was because I thought that the novel drugs (non-chemo) would do less collateral damage and if everything failed, I could still go back to the conventional treatments. Enzastaurin gave me a year with virtually no side effects (OK, it changed the color of my urine to orange, but who is going to know that?), but then stopped working. I've been on LBH-589 since February 2010 and have been stable since then.

The whole trick to surviving WM is knowledge of the drugs that are available to you and picking the right drugs. Sadly, most physicians never encounter WM, and few have any clue what the state of the art is. You have to do that research yourself (like by reading this page and my "drugs" page). Sadly, if you aren't reading this page, you'll go to a physician who provides "standard of care" treatment for WM that will likely include drugs like Velcade (which causes peripheral neuropathy (PN)), cytoxan, bendamustine, etc. You may not do as well as someone who is self-educated on the safer and equally effective alternatives. But there are people who have done well on conventional treatments. So there are opinions both ways. For sure, stay away from Velcade and any other drug that gives you PN!

My personal strategy is staying away from treatments which permanently damage your cells (like chemo drugs), and only switching regimens when the treatment stops working. Basically, there are finite number of drugs out there that are effective with little side effects. If you get lucky, you find one with minimal to no side effects that works for you.  Fortunately, there are many many options to choose from for this disease. And fortunately the disease is slow growing, so you have time to switch to different drugs.

I'm still on LBH-589, but unfortunately, I think you have to be on a clinical trial to get it and I think they are all closed. Enzastaurin bought me a year. The "hot" safe drug nowadays is Ibrutinib. RAD-001 is another drug you can get, but Ibrutinib seems to work better for most people. Rituxan solo can buy you a lot of time and is relatively side effect free. See my Waldenstrom's macroglobulinemia: Drug options for all the options (and the downsides).

Because it is such a rare disease, there are a lot of doctors who will just go with the "tried and true" proven therapies. Do no harm. Sure, these are relatively safe, but it's very clear to me that the novel agents available for WM (i.e., not chemo drugs) are much easier for your body to handle and can keep you stable with minimal to no side effects or permanent damage. To me it is a very bad idea to start with a chemo drug.

You are ultimately responsible for making the decisions as to what to do and so the more you know, the better equipped you are for making the right decisions. In my case, I opted for the “easy to tolerate, no permanent bad side effects” stuff first, before going to the more harmful chemo treatments, and then returned to the novel drugs. My treatments are documented on the Kirsch Waldenstrom's Macroglobulinemia Diary page. Basically, I started with one round of CPR, then Rituxan solo, then enzastaurin for a year, and now LBH-589.

See Waldenstrom's Macroglobulinemia talk by Steve Treon for a recent talk by Steve Treon, one of the leading researchers in the field (well it was recent when I wrote that 7 years ago).

So far, the only side effect I have is a small amount of permanent vision loss in one eye because one of my physicians didn't read my blood test results for a week after my blood test. I had an IgM spike (very common with Rituxan) and so my blood viscosity went through the roof.

Moral of the story: NEVER NEVER solely rely on your physician to read your results in a timely manner.

I had diabetes for 7 years according to my blood tests (I had a glucose reading over 200) and NOT ONE SINGLE DOCTOR EVER POINTED IT OUT. Simply unbelievable how bad the medical care is. A computer would do a much better job. The sooner we augment doctors with computers, we'll see a massive improvement in medical outcomes.

Also, on one of the clinical trials I was on, I noticed a nosebleed and found my platelets were dangerously low; had I just followed the protocol as written, I might have had permanent brain damage. Fortunately, I caught it in time and did not sustain any damage. The moral: you are ultimately responsible for your own care so be involved and monitor your progress. If things seem odd to you, get it checked out. If you take Rituxan, get your blood tested after the infusion and make sure you get the results right after the test. NEVER assume that your physician is always looking out for you. That mistake could have caused me to lose a lot more of my vision than I already lost.

If you are lucky enough to find an experimental drug that works for your case, you can survive for decades. I was lucky. It took me only two years to find a drug that keeps my Waldenstrom's under control (LBH-589, one small 20mg pill taken 3 times per week). This drug has minimal side effects, so minimal I couldn't tell you what they are because I can't find any side effects. Most people would never know I have cancer. I have more energy than most people I know.

What follows is the text I wrote after I was first diagnosed. If you just got diagnosed with WM, you might have already gone through the same thing I did.

My name is Steve Kirsch. I am a serial entrepreneur and philanthropist (see Steve Kirsch Wikipedia profile). I was recently diagnosed with a rare, incurable blood cancer that might kill me. I have enough time to change the outcome and I'm going to try to do that. This is my story.

I've had monoclonal gammopathy of undetermined significance (MGUS) since at least 2000 when a high sedimentation rate (ESR) caused my doctor to refer me to a hematologist, Steven Coutre at Stanford. The ESR is basically like the "check engine" light on a car. It signals that something is wrong. Coutre discovered I had an elevated IgM of 1260 (which explained the high Sed rate because the huge quantity of IgM basically skews the Sed rate test). MGUS is a fancy way of saying that there is something abnormal about the plasma B-cells (aka plasma cells) in my blood that is causing them to produce huge quantities of the IgM class of antibodies. These diseased plasma cells live virtually forever (it is believed that they originate from memory B cells which normally live for decades whereas normal plasma cells have a lifetime of months), they produce antibodies continuously, and they keep cloning themselves. On my most recent physical in 2007, my blood test indicated I was anemic. My Complete Blood Count (CBC) had a low hemocrit (HCT) of 31.9 (which explains my anemia), a low hemoglobin (Hgb) of 10.6, and a low red blood cell count (RBC) of 3.72. However, my platelet count (PLT) was high at 524, and fortunately my white blood count (WBC) is normal at 9.5. My metabolic panel showed a high globulin (6.8), a high total protein (9.6), a low albumin (2.8), a slightly high creatinine (1.2), and a high glucose (141).

On July 3, 2007, I saw Coutre again who, after looking at my blood tests and doing a physical exam, conjectured that my MGUS had progressed to full Waldenstrom's macroglobulinemia (WM) which is a type of lymphoplasmacytic lymphoma. He had warned me back in 2000 that this was a possible consequence of my MGUS. Light chain analysis shows my my IgM light chain is kappa (80% of WM patients are IgM kappa; the other 20% are IgM lambda). Electrophoresis showed that my monoclonal IgM (aka M-spike) has more than doubled to 2.7 g/dl (which is about 10 times higher than normal), and I have a high kappa/lambda ratio of 1.83 (most WM patients have a higher kappa) and a high Beta-2-Microglobulin of  2590 ng/mL. He advised me to do a bone marrow biopsy (BMB) to confirm the WM diagnosis which I did the same day.

Tip: The BMB isn't exactly fun. The CT- guided BMBs are usually less painful. But a really good physician can also do a good job especially if he drugs you up before the procedure.

On August 10, I inquired as to the result of the bone marrow biopsy test and they faxed me all my test results. The results of the biopsy are variable depending on where you take the sample from (your WM is NOT uniformly distributed) so one sample isn't really definitive. However, it's the best we have; it's the "gold standard." The biopsy confirmed Coutre's diagnosis with a 10% to 15% involvement of lymphoplasmacytic lymphoma. In other words, it's quite possible that I'm going to die soon. That was a real shocker. And wow, I didn't even getting a phone call from the doc telling me the bad news. I had to call them!

Today, according to all the peer reviewed papers I'm aware of, WM is, for most people, an incurable death sentence. The Shah of Iran, former Algeria President Houari Boumedienne, and former French President Georges Pompidou all died from WM. According to the medical literature, half the people die within 5 or 6 years from first diagnosis. 80% are dead within 10 years (see page 8). It is very serious stuff.  You will likely either die from the disease or from the treatments you take in trying to fight the disease.

Fortunately for me, WM is a slow moving cancer and there are many people who have lived 20 years or more with WM. Today's treatments, such as Rituxan, LBH-589, RAD001, etc. dramatically increase the median survival time. The numbers cited in the peer reviewed papers are based on old data. The reality is that we won't know the latest numbers until the people who are on the current treatments die. So the currently published mean survival rate numbers are always backwards looking and somewhat on the pessimistic side. So that's the good news. I've probably got at least 10 years left.

The International Waldenstrom's Macroglobulinemia Foundation (IWMF) is emphatic that you are more likely to die with WM than from WM. That's absolutely true. A retrospective study of 337 patients done in 2006 by Dr. Irene Ghobrial, et al. (Br J Haematol. 2006;133:158-164) showed a median disease-specific survival of 11.2 years (from time of eligibility for treatment) and, more importantly, a median survival from all causes of 6.4 years from the date of diagnosis. That last number is troubling since the 6.4 year timeframe would include people treated with newer drugs such as Rituxan which was approved November, 1997. However, it's skewed in terms of age so since WM strikes later in life, your mean life expectancy is pretty low at those ages, even if you didn't have WM. If you measure from the time of diagnosis (rather than start of treatment), then it is 12 to 19 years.

So statistically, once you are diagnosed with WM, more than half the people make it past 6.4 years, even though most of the deaths are not from the WM itself. More meaningful would be the median survival from all causes for people who are diagnosed at my age. Unfortunately, that number isn't readily available. Not that it would make a difference though. As of December 2007, my WM had progressed to affecting my vision so treatment isn't optional. I'm on the treatment train and so my objective is to halt or reverse this disease without killing the patient.

At the Atlanta IWMF conference in 2007, Joanne Pavia asked, "We're told we don't die FROM WM, but WITH it. Yet we also see lifespans mentioned.  If the WM isn't killing us, what is?" Almost all the doctors weighed in. They basically said it's the treatments that weaken our systems, our organs, in addition to the WM itself, and we contract other illnesses, sometimes as a result of those treatments, that do us in.

While you have WM, the symptoms can range all over the place. A lot of people don't miss a beat and have virtually no symptoms. Others report symptoms (from either the WM or the treatments) including peripheral neuropathy (often caused by Velcade and by unnessary chemo such as Vincristine and other "-ines"), the WM and can be so bad that you cannot work), blurred vision, fevers, weakness, mental fog (which can inhibit productive thinking and reasoning), severe anemia, enlarged spleen and liver, enlarged internal abdominal lymph nodes, liver damage, severe fatigue, anemia, nose bleeds, transient stabbing pain, low energy, nasty attitude, sweats, loss of appetite, weight loss, rashes all over your body, swelling and pain in elbow, hands, or feet (that even morphine won't stop), permanent muscle weakness, more likely to get an abnormal type of shingles (often due to Fludarabine), coma, blindness, deafness, and so on. And WM can morph into other bad diseases like Diffuse Large B-Cell Lymphoma (DLBCL). So depending on the person, it can range from not noticeable to severely debilitating. Some drugs increase your susceptibility to shingles. When the IWMF recruited fundraisers from the membership, they found that 20% were so disabled that they couldn't work.

I'm 50 years old as I write this. I checked my prognostic factors using this paper summarizing the survivability data (see the last page). Risk factors include age, level of beta-2-macroglobulin, low hemoglobin, and low platelet count. According to that paper, I have slightly more than 5 years left. However, that paper is based on old treatment protocols so the survivability prognosis is better today than it was but I don't know how much better. Statistically, I have to acknowledge the fact that, while unlikely, it is possible that I'll be unable to see my youngest daughter graduate from high school. It's possible that I won't even be around even to see her graduate from elementary school. This is a great disappointment for me. But what really hits home for me is thinking that my youngest daughter may not have a Dad who is around long enough to see her graduate from elementary school and that my second youngest daughter will have a father who might be dead before her high school graduation. And that I will be leaving my wonderful wife Michele with a family of three kids to raise solo. All those wonderful plans we had about how we were going to spend the rest of our lives together...those plans have...well, shall we say... changed.

WM is a rare blood cancer. Less than 1,500 people per year are diagnosed in the US. Funding from the government is almost non-existent because the numbers are so low it's considered an orphan disease (the only researcher in the country with an NIH grant for WM is Irene Ghobrial at DFCI).

Despite the description of this disease by Dr. Jan Waldenström in 1944, until very recently, very little progress into the pathogenesis and treatment of this disease has occurred over the past 63 years. Thanks to the dedicated work of research groups at Dana Farber and other locations, fundraising efforts by people associated with the IWMF and the RFW, and generous gifts from wealthy WM survivors such as Peter Bing, there has been a lot of progress that has been made on this disease over the past 10 years.

The International Waldenstrom's Macroglobulinemia Foundation appears to be the largest funder of research; to the tune of less than $2M per year. I looked at the list of contributors to the foundation. It is dominated by people who gave "In memory of ..." I cried when I read that. Then I imagined my name being added to that list in the not too distant future. How sad is that? A disease whose research is, in essence, being funded by a bunch of dead people.

You are probably wondering, "why doesn't the government fund this? After all, more people in the US die each year from Waldenstrom's than from terrorism!" See The real enemy isn't the terrorists for my opinion on this.

Due to the limited funding, there are less than 35 researchers in the whole world focused on this disease. There is an international meeting of everyone working on Waldenstrom's macroglobulinemia that happens every few years where researchers share their research. And there is a research group at Harvard that is spearheading national and international efforts to bring innovative basic and clinical studies to WM.

Even though the disease has been known for more than 60 years, there are still no FDA approved therapeutic agents for the specific treatment of WM. There are about a dozen different treatment options: chlorambucil and prednisone, and more recently, fludarabine (Fludara) and cladribine. All of these are chemo therapy that kills everything in sight and there can be permanent side effects (like kidney failure). There is also a relatively new drug Rituxan which is an anti-CD20 monoclonal antibody. Combining the drugs has shown to be more effective than a single drug. Alone they are all about equal in effectiveness. They can reset things for a while but eventually, the cancer always returns. And the remissions get shorter and shorter each time. Rituxan, which is the most targeted and has the least side effects can kill you within 24 hours after you take it (0.4% chance), it takes about 3 months or so before you know whether it is working, and typically only works for 8 months before symptoms degrade again but it is often only 6 months and some people have reported things start going bad again after only 2 months. So if it takes 6 months to get the max effect, then you'll be back where you started after 12 months (a very symmetrical cycle). Even if you go on "maintenance Rituxan," some people believe that can only be used safely for about 2 years. The good news is that maintenance Rituxan will somewhat extend your lifespan. But typically, only about half the people will receive a benefit. And many people are allergic to it and can no longer take it (even after being treated successfully many times). This is presumably due to the fact there are mouse antibodies in it (there is a human version coming out soon). There are other options such as stem cell transplantation (SCT) which is risky and has up to a 12 month recovery period and plasmapheresis (PP) which is supposed to be risk free, but only lasts a very short time and only affects blood viscosity. I know people who tried PP and found that the results were worse than the nerve damage without the treatment so they opted for the permanent nerve damage instead of the treatment. Each patient is different in their reactions to the treatments, there are no miracle drugs that almost always work, and all the treatments carry some amount of risk and side effects (sometimes permanent). So it's not like there are a lot of great options to choose from.

For a list of drug options, see Waldenstrom's macroglobulinemia: Drug options

Statistically, I probably have more than 5 years to live. What do I plan to do? Not the protocols that anyone else has used before. Those don't work. Here's a plan that I think has a great chance of stopping or curing this disease: My treatment plan.

Having been involved in medical research through the Kirsch Foundation, I know that medical research normally takes at least five years, and more often a lot longer, to find answers to problems, even if you do everything right as we did with Catalyst for a Cure which has made remarkable progress in finding a cure for glaucoma. So if my treatment plan doesn't work and we have to do more research, it's possible that whatever I do to find a cure may likely be too late to save my own life.

But that doesn't mean I shouldn't try. I remember as a kid learning the old saying that "nobody ever won a chess game by resigning." Who knows. Maybe I will get lucky.

I believe that people make their own luck. I think my best chance of survival is to advance the science by  intelligently directing funds into research that is likely to do the most good including bringing in fresh eyes from outside the field.

It appears that there is very little money being applied to the research and the research is focused more on finding the best treatments rather than in understanding the underlying mechanisms that cause the disease.

My strategic bet is that if we are to cure this disease, it won't happen by doing the same things over and over and expecting a different result.

That's why I developed my treatment plan.

In parallel with that, I'd take much the same approach we did with Catalyst for a Cure: raise the funding, find a chair for the Science Advisory Board who is world class, find researchers in complementary fields, get an animal model, and focus the entire collaborative effort on first understanding the cause and the mechanisms, e.g., by profiling changes in gene expression using micro array analysis.

Having an animal model of WM is extremely helpful. For glaucoma, we had mice with the disease which was critical to making progress. Fortunately, we can now do the same with WM as described in this 2005 paper, A SCID-hu in vivo model of human Waldenstrom macroglobulinemia, where they transplanted human bone marrow into mice which then manifested the disease.

So we are actually in a very good position to make significant progress.

I've listed a bunch of questions we need to answer and treatment approaches than might be available.

However, the reality is that few people are going to get "excited" about giving massive amounts of funding to a disease that they have a low chance of getting. So I thought that the scope of the research would need to be broadened to "lethal orphan cancers" since the dollars a donor would give may very well end up saving their own life someday, just like it might save mine. But when I test marketed this concept with friends, they told me that if they were going to give a donation, it would be specifically for my disease in order to help out a friend. Therefore, a more generic mission would, to my surprise, make them less likely to give.

The objective of the effort is to develop "wonder drugs" for orphan lethal cancers similar what Gleevec did for chronic myeloid leukemia (CML). For that rare blood cancer which affects the same number of people per year as WM, nothing worked. It was a death sentence with only about 2 or 3% of patients achieving any kind of remission. With Gleevec, the statistics are reversed: 98% of patients achieve full remission without side effects and 87% have experienced a correction in the gene mutation that causes CML.

So it's been done before. The scientists working on WM believe can be done again for WM. We just need to put the necessary money and talent to work rather than starving them for research funds like we are now. That just makes no sense.

Today, my government spends nearly zero dollars on funding research for my disease . There is currently only one grant from the NCI specifically for my disease (to Irene Ghobrial at Dana Farber for $215,000 per year for just two years).  In order for me to save my own life, I will also try overcome a more serious problem which affects us all: The real enemy isn't the terrorists.

The bottom line is this: while I am optimistic that I'll survive for a lot more than 5 years, and hopefully more than 10, I also must be realistic and cannot discount the possibility that it could be less than that. Nobody knows for sure. Nor does it matter. My "to do" list wouldn't change.

Fundraising for the disease

There are many ways to generate ideas for research projects for this disease. Here are a few:

• invite investigator hypothesis driven grant proposals
• convene a workshop for the best people in the WM/NHL field
• convene a meeting of some of the best people in medicine in related areas to meet with the WM researchers
• ask a few of the top WM researchers to come up with a strategic 5 or 10 year game plan
• put together a team of 4 or 5 scientists who are not currently working on WM, focus them on WM, and let them generate new ideas. We did this successfully with glaucoma, for example (see Catalyst for a Cure)

Once there are people, ideas, and projects to fund, then are then two basic approaches for how to evaluate which ones to fund:

1. Ask two or three scientists who have the best track record of accomplishment
2. Ask a much larger Scientific Advisory Board

And there are two basic ways to give out grants:

1. Give out a long-term team grant for a long-term strategy where all the efforts are coordinated and sharing is encouraged since the team no longer has to "compete" for grant dollars
2. Fund individual investigator initiated hypothesis grant proposals

Both approaches are useful and it isn't clear which is better. Since the IWMF is already allocating millions of dollars each year using the second approach, I thought it would be useful and complementary for me to help raise funds for the first approach. That way, we hedge our bets and have the most chance of curing this disease.

I am also a big believer in the "trust the judgment of a superstar." For example, in financial investing, the "group of smart guys approach" to investment decisions hardly ever beats the judgment of a single smart individual. For example, Yale beats every college in the country because there is one guy there (David Swensen) who is really smart who makes the final decision on every investment. It is not "investment by committee." It can be argued that investing in medical research isn't that much different. In fact, I am personal friends with the guy who runs the top medical investment fund in the country. He makes all the decisions.

If you want to help fund research, make a donation at the IWMF website.

My goal is that by providing another option for donors, that we will increase the total funds available for fighting the disease which benefits everyone with the disease. Because the SAB is very small, grant decision can be made very quickly when required. Some money might be used to sponsor critical clinical trials when necessary or support seed funding to a new idea even if it lacks sufficient data for a formal proposal.

It's quite likely that all of the funds raised may be used to attract and cultivate a few new researchers into the field who are executing a long-term coordinated strategic plan of attack and have a framework for collaboration. So there would be a focus on a team grant with a long-term plan rather than individual grants and sponsoring 3 or 4 people at different institutions over a 5 year commit period rather than projects. So it is like the Howard Hughes Medical Institute but with more coordination among the Fellows and a common long-term plan. By sponsoring a team of 3 new researchers over a long time period where the objectives and milestones are team oriented there is less incentive to keep secrets and more incentive to share information because everyone's funding is guaranteed over the long term, but the long-term continuation of funding is based on the team's progress. The Kirsch Foundation used this model quite successfully for glaucoma  (see Catalyst for a Cure).

I'm also funding research done by Irene Ghobrial (pictured below) at Dana Farber through the Kirsch Laboratory for Waldenstrom Macroglobulinemia (see Kirsch Laboratory for Waldenstrom's Macroglobulenemia 2010 Annual Report).

My "to do" list

• Keep a positive attitude, stay healthy, eat right, exercise, stay hydrated, avoid vaccines with live viruses, and see the best doctors. If treatment is required, choose the one with the least side effects and give it time to work. Keep track of my hemoglobin and hematocrit levels.
• Build upon the work that has already been done by the IWMF and RFW to get more research $ dedicated to this disease. For example, we need to fix the federal funding of this disease and for other orphan cancers that are getting the short end of the stick. For example, right now, there is virtually no government money spent on research for WM; just one small research grant. Yet almost 10 times as many people die from this disease each year than die from terrorist attacks! Talk about misplaced priorities! See the real enemy isn't the terrorists for some amazing facts. At any rate, we need to increase the NCI budget, we need to get more funding for the Cancer Genome Atlas work that NCI is already doing (they had to squeeze the funding for this critical project by cutting other projects), and we need to get funding for these orphan cancers that is at least proportional to the number of people affected so that everyone is treated fairly. This is going to involve a lot of public policy work and work on getting groups to work together to raise public awareness about the shortsightedness of the lack of NCI funding (which has been going down every year). Currently, these groups are all focused on their own disease and, as a result, the bigger picture isn't being addressed. We need to fix that.
• I've suggested to the board of the Kirsch Foundation that they consider funding research on this disease. There are two reasons for this: 1) they have sufficient assets that their money can make a huge difference in the amount of research that can be done and 2) there are critical research projects that need to be funded in order for scientists working on this disease to know the basics of this disease. Note that because the Kirsch Foundation is a public charity, even though my wife and I provided virtually all of the money for the foundation, it is up to the independent board members to decide whether or not to spend it on this disease. Because I'm affected by this disease, I cannot vote on matters relating to the funding research for the disease since that is a conflict of interest (even though the research benefits everyone with this disease equally).
• Get a short white paper written that summarizes the latest knowledge of what is known about the mechanism for this disease. People from outside the WM field are always telling me, "I have something that might work"  but they need to be able to read a paper that summarizes what is known about how the disease operates (e.g., that the WM cells are abnormal plasma cells that are immortal, etc.).
• Help to get a meeting of top scientists from outside this field to learn about WM and the research approaches and suggest new ideas and strategic approaches
• Help to get a meeting of top scientists from inside this field to either validate the current research projects or suggest new ideas and strategic approaches
• I will work to get money from other private and public sources applied to this disease.
• Improve the investment portfolio of the Kirsch Foundation so that, if they decide to fund this disease, there will be more money available.
• I've asked the research team at Dana Farber to come up with a comprehensive plan to cure this disease including defining the state of knowledge, the rate-limiting issues, and leveraging opportunities. The plan covers doing all the "catch up" research so that we've done the basic science that is needed in order for us to make breakthrough. It will take close to $50M in order for us to get to the same level of knowledge for this disease that we have for other cancers. 
• I have contacted my Representative and US Senator personally and both have told me that they will do whatever it takes to correct the injustice.
• I have located key personnel within the NIH and in other advocacy groups so we can put together a plan for dramatically increasing the NCI budget and for getting funding equity for orphan cancers.
• The IWMF is already doing a great job of spreading out funds, so a concentrated effort at Dana-Farber focused on the basics would actually be very complementary to what is already being done. So I am trying to raise funds for that effort.
• Spend more time with my family
• Get my affairs in order (which is good advice for anyone!)
• Cherish each day

Steve Kirsch's Waldenstrom Macroglobulinemia links