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Poppin' Pills

Posted by Frederick Wasti
Mar 31 2012

The main drugs that I am or will be receiving in my Dana-Farber clinical trial protocol are Ofatumumab, Methylprednisone, and Alemtuzumab. The first two are administered intravenously, while the third will be administered subcutaneously.

However, while less "glamorous" (<g>) than the above medications, there are a few other medicines that I also have to take daily, by mouth, as pills. These are to help deal with two related factors:

First, as a person with leukemia, my immune system has already become compromised, so that I may be significantly more susceptible to infections (bacterial, viral, and/or fungal) than are most persons.

Then, as a patient being treated for leukemia, my immune system needs to be further damaged in certain specific ways in order to eventually start to improve it. (In other words, this ~is~ a case of "things getting worse before they get better".)

Therefore, I do have to take three prescriptions daily, as follows:

1. Sulfamethoxazole/Trimethoprim, a.k.a. Cotrimoxazole (generic) (brand name Bactrim) -

Cotrimoxazole is a combination of two antibiotics (Sulfamethoxazole and Trimethoprim) used for the prevention or treatment of a variety of bacterial infections of the respiratory system, the middle ear, the urinary tract, and the intestines.

In particular, Cotrimoxazole is effective on Pneumocystis pneumonia, which is a form of pneumonia caused by the yeast-like fungus Pneumocystis jirovecii. Pneumocystis is actually commonly found in the lungs of healthy people, but their normally functioning immune systems keep it in check. However, Pneumocystis can bring about an opportunistic lung infection in a person with a compromised immune system.

In a perfect example of synergy, the combination of Sulfamethoxazole and Trimethoprim is more effective than either of the components are individually. What the two antibiotics do, in a "1-2 punch" action, is to separately interfere with two consecutive steps in one biosynthetic pathway in certain bacteria and fungi - this ultimately prevents certain essential proteins in these "bugs" from being manufactured.

2. Voriconazole (generic) (brand name Vfend) -

Voriconazole is an antifungal medication that is used for the prevention or treatment of certain serious, invasive fungal infections, sometimes seen in persons who are immunocompromised. Examples of these infections include candidiasis (a fungal infection of the skin, mucous membranes, or digestive tract), and invasive aspergillosis (a deadly fungal infection that begins in the lungs and then spreads through the bloodstream to other organs of the body).

Voriconazole is in a member of a class of antifungal medications called triazoles. It works by interfering with one critical step in a biosynthetic pathway necessary for fungal cell wall production - technically, it does not so much kill fungal cells as it prevents them from reproducing (which requires new cell walls).

3. Acyclovir (generic) (brand name Zovirax) -

Acyclovir is a very commonly used antiviral drug, employed primarily for the prevention or treatment of such viral infections as those caused by the herpes simplex virus (cold sores, fever blisters, genital herpes, etc.), the varicella zoster virus (chickenpox), and the herpes zoster virus (shingles).

Viral infections can arise from picking up new, recent viruses, but they may also come from viruses that entered the body many years previous, and which still remain in the body, kept in an inactive state for many years by a healthy immune system, but which can become reactivated in a person with a compromised immune system.

From my clinical trial consent form - "Risks Associated with Ofatumumab: [...] Rare: Less than a 1% chance that this will happen [...] Progressive Multifocal Leukoencephalopathy (PML): A rare and severe viral infection of the brain. PML can cause brain damage, memory loss, trouble thinking, muscle weakness, blindness and death."

NOPE! - DON'T want ~that~ virus... (<g>)

Again, from the same consent form - "Risks Associated with Alemtuzumab: [...] Frequent: Between a 10-50% chance that this will happen [...] CMV (Cytomegalovirus) reactivation without infection. Detected on routine monitoring and treated. This is a virus that may be carried in an inactive state for life by certain individuals. It can be a cause of severe pneumonia in people with a suppressed immune system, such as those with lymphoma or leukemia."

NOPE! - do NOT want ~that~ one either... (<g>)

[As an aside, please note two ~VERY~ important points made in the above quote about CMV - First, I will be monitored routinely for CMV reactivation (and the odds are pretty good that I do not have the CMV virus in my body anyway), and, second, it would be treated if it did occur. So, not to worry...]

Acyclovir doesn't actually "kill" viruses (which are not really alive), but it does help to slow or stop the spread of virus particles. Acyclovir is not actually an antibiotic - antibiotics work only on living pathogens, and viruses are "merely" nonliving chemical "beings" of sorts.

Technically, Acyclovir can be referred to as a "prodrug", since it is in a relatively inactive form as it is administered, but it then is modified into a more active form within a patient's body.

Finally, interestingly enough (well, at least ~I~ think so - <g>), Acyclovir was originally extracted from a particular Caribbean sponge!

Well, the bottom line is that taking a handful of pills each day may be a bit of a nuisance, but it is a ~lot~ nicer than developing any of the above infections due to having a compromised immune system from leukemia and from leukemia treatment.

Categories: Leukemia