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Uh-Oh - Plateau

Posted by Frederick Wasti
Apr 25 2012

A week ago I said, "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..."

Unfortunately, the optimism that we had felt then - that three more rounds of Methylprednisone last week might have "jump started" a renewed decline in white cells - has not been realized.

First, let's take a look at the total leukocyte count since the clinical trial started:

As can be seen, the last three Wednesday blood tests do not show a continuing downward progression.

If we look at the last three Wednesday results in a different context, in a graph of the total leukocytes from the time of diagnosis, it looks like this:

If you look quickly, it maybe all looks like good news. However, if you zero in on the most recent three results (in the circle), what is going on in my blood is that my total white cells are simply no longer continuing to go down.

Let's look at the lymphocytes specifically this time - here is what has been happening to the lymphocytes from the time of diagnosis:

Not surprisingly, since the lymphocytes had become my most abundant type of leukocyte, and since it is the lymphocytes that the treatment is supposed to be bringing down, this graph looks a lot like the second graph, that of the total leukocytes since diagnosis.

We did speak separately today with nurse Kathleen McDermott and nurse practitioner Michele Walsh about this seeming lack of continued progress. Both expressed the same disappointment, but we all realize that this is "a work in progress". The counts ~may~ start to come down again as we continue the clinical trial Part A protocol (or they may not). It is possible that dramatic changes will start taking place again during Part B (which involves Ofatumumab once again, but without high doses of Methylprednisone alongside it, and with the addition of Alemtuzumab to the arsenal).

It is also quite possible that substantive events are going on right now, even if they do not seem to be showing up in blood test results. Lymphocytes are found in three main areas of the body - the bone marrow, the blood stream, and the lymphatic system (i.e., the lymph nodes and spleen). Blood counts can only show what is going on in the blood, and are quite oblivious to possible changes in the lymph nodes and marrow.

I am scheduled to have a CT scan on May 4th, so we may be able to learn of some positive changes to my lymph nodes and spleen at that time. (There were only two lymph nodes that I could personally detect previously, both below my right ear, just behind the angle of my jaw, and those "shrank to nothing" on the first day of treatment, but I/we have no idea as to what has happened since then to the rest of my internal lymph nodes and my spleen, which were previously known to be enlarged) - that's why, of course, this CT scan is to be made.

There is also some evidence of positive changes in my bone marrow, both from my improving platelet counts and from the bone marrow biopsy ("BMB") I had back on March 14th, and I will likely have another BMB in a few weeks, at the end of Part A. So, we may have further good news regarding the bone marrow still forthcoming.

I guess all of this is to say that, while it is disappointing that the blood tests have stopped showing dramatic improvements, it still is possible that good things are continuing to take place. The fact that all is not as predicted is at least partially because all of it cannot be predicted - a clinical trial is, after all, an experiment, right?

Categories: Leukemia