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Cycle 2 Day 3

Posted by Frederick Wasti
Apr 20 2012

Well, the "busy first week" of Cycle 2 (the first week of every cycle in Part A of the clinical trial is a "busy week", involving three days of infusions) is over. The noticeable after effects on Day 1, which involved several infusions, including full dose Ofatumumab, were a little stronger than expected (although still quite tolerable), while the noticeable effects from Days 2 and 3, which involve only full dose Methylprednisone each day, were/are pretty tame. As I write this, on Friday (Day 3) afternoon, I am feeling pretty good - the only effect that is pronounced is the "foggy" vision I have as I type (things are not out of focus, but I just notice a subdued color sense and overall lack of contrast, and I know that this is likely to be gone by tomorrow morning anyway).

I did have a visit from Dr. David Fisher this morning, to go over some questions I had, and I'll come back to most of that later. But, first I would like to go back to my cursory description of Wednesdays good and not so good results, bringing in some graphs to illustrate this time:

I did mention in the 3/18 blog entry that, "For the blood test results after the fourth week of testing, there was a bit of a disappointment, in that the white cell counts (including the differential lymphocyte count) did indeed go down once again, but not by all that very much this time, making for a shallower slope for the curves on the total white cell graph and the lymphocyte graph - still in the right direction, but not so determinedly so. (Maybe I'd been "spoiled" so far.) Bummer..." Well, let's take a look at some graphs:

First, here is a graph of the total leukocyte count since starting the clinical trial (and a couple of pre-trial visits) at D-F:

It can be seen from the above graph that my total white cell count did go down again in Wednesday's blood tests, but the rate of decline was considerably smaller than the decline from previous treatment weeks.

To put these data into more of a historical context , let's take a look at how the total white cell count has varied since the time of diagnosis:

It can be seen (if you look closely - <g>) in the above graph that the results from Wednesday's tests just barely made a slightly lower dot at the end of the curve.

I did discuss with Michele Walsh (Dr. Fisher's nurse practitioner) on Wednesday, and with Dr. Fisher himself this morning, as to their thoughts about the slowing of the total leukocyte count decline. Both separately suspected that, not having had the full dose of Methylprednisone since Week 1 of Cycle 1, the Ofatumumab, perhaps acting more or less alone by the time Week 4 of Cycle 1 came along, was not able to be as effective by itself. (I had known from my own research that CLL rarely responds to "single-agent therapy", and that it usually requires two or more agents acting together and acting synergistically to make a dent in the disease.)

Both Ms. Walsh and Dr. Fisher expressed the hope that, since I did receive three rounds of full dose Methylprednisone (along with a round of full dose Ofatumumab) this week, that next week's blood test results may show a renewed rate of decline. (We all do have to remember that this is an ~experimental~ clinical trial, and not all is known to occur according to plan.) (Of course, all may not go according to plan for every patient undergoing even so-called "proven" therapies - <g>.) I am optimistic that both Michele Walsh and Dr. Fisher are correct - it all makes sense to me.

Now let's take a more specific look at how the lymphocytes themselves have changed (both as a percentage of the total white cell count and as an absolute number of cells per microliter):

As with the total leukocyte graphs, it can be seen that the lymphocytes have also declined once again during Week 4 of Cycle 1, but that the rate of decline had leveled off quite a bit. However, the shared optimistic expectation by all concerned is that, after receiving three rounds of full dose Methylprednisone along with a round of Ofatumumab this week, the lymphocyte count will lead a downhill charge, taking the total lymphocyte count along for the downslope ride. :-)

Remember, though, that there was also good news from Wednesday's blood tests: I also pointed out in the 3/18 post that, "On the other hand, my platelet count continues to rise, and this indicates that my bone marrow is definitely still improving - i.e., it is still being cleared of excessive lymphocyte stem cells, and of their excess new and immature offspring. :-)" So, let's take a look at how the platelet graphs appear:

 

Notice in the above two graphs that the platelet counts had been in decline until treatment started, but had started improving once treatment began. This is significant in at least two respects:

1. Since platelets are necessary for proper clotting of blood, it should be evident that a declining platelet count is not good news. In fact, with CLL, having a platelet count drop much below 100 is often an indication that treatment should be begun and that the time of "Watchful Waiting" is over. (The normal platelet count should be a lot closer to 300 or so - that's about 300,000 per microliter or per cubic millimeter.)

2. Since platelets are manufactured in the bone marrow, a declining platelet number is evidence that the marrow is filling up with too many aberrant lymphocyte stem cells and their immature offspring, crowding out other healthy marrow cell processes. But, conversely, a rising platelet count is evidence that the clutter of excessive lymphocyte production is starting to be cleared away, and that is ~very~ good news indeed.

So, while Wednesday's blood test results were not quite as gratifying as were those from other recent Wednesday, there was still some good news to report, and we all have some guarded optimism regarding next week's blood test results. :-)

Diane and I did have a good discussion with Dr. Fisher this morning about the possibility/probability of undergoing a stem cell transplant procedure sometime soon, but I will leave a discussion of this until my next blog entry. (So as to not keep you in too much suspense until then, I will let you know here that Dr. Fisher - as well as Michele Walsh on Wednesday - said that there is no reason to go rushing headlong into a stem cell transplant just yet, even though I may want to consider one in my not too distant future.)

Categories: Leukemia