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Cycle 2 Day 22

Posted by Frederick Wasti
May 09 2012

We got home a little while ago this afternoon from Dana-Farber in Boston, having spent much of Day 22 of Cycle 2 there for another infusion of Ofatumumab. Things went pretty smoothly, I guess, although I am still pretty groggy as I type (from the Benadryl preconditioning before the Ofatumumab).

We did have a meeting with Dr. Fisher today, and we're continuing to push onwards. Dr. Fisher attributes the pulmonary embolism as mostly due to "simply" having leukemia (as opposed to the ~treatment~ of leukemia), since there is a correlation between having leukemia (and in having cancer in general) and developing blood clots that can sometimes result in a pulmonary embolism.

Well, regardless of the cause, we're dealing with it - the embolism is being treated. I will continue to inject myself subcutaneously in the abdomen with Fondaparinux for a total of six months (gee, that's about 180 "pokes" - <g>), but, so far, it's not all that big a deal (and it's not a small target, anyway - <g>).

Dr. Fisher did provide us with the results of this morning's blood tests, and it does look like things continue to improve. Here's how the total white blood cell count looks, from the time of diagnosis until today:

The first place I look on such a graph is the far right part of the curve, which does show a mostly downward trend since the start of treatment. The slope is not quite as steep as it was during the first couple weeks of treatment, but, as the bottom of the graph is now "almost in sight", any steep line might take the white cell count all the way to zero, and that would not be a good thing - <g>.

For perspective, here's the graph for my known WBC count history:

I will note a couple of things at this point (well, OK, maybe three or four - <g>):

First, my total white cell count today is the lowest it's been since perhaps early 2008.

Second, depending on whether you consider the normal WBC count range to be 5,000 to 10,000 (per microliter), or 6,000 to 9,000, or 4,000 to 11,000, my white cell count today is back to within the normal WBC count range for the first time since perhaps late 2008.

Third, despite the above two statements, I cannot be considered to be, even remotely, free of leukemia. I still have an unbalance of numbers of cells of each of the cell types, I still have proportionally too many lymphocytes, most of my too-rapidly-produced lymphocytes do not function correctly, the number of neutrophils (especially) is still too low (although gradually getting better), I still don't have a proper number of platelets, and - perhaps most importantly - the vast majority of the lymphocytes I have are almost certain to still be leukemic.

Finally, if I use my preferred "normal" WBC range of 5,000 to 10,000 (the range I employed when teaching Human Anatomy and Physiology at Bristol Community College back in the 1980s and 1990s), I now have, leukemia without also having leukocytosis (defined as too many white blood cells) for the first time in my life. (Interesting trivia, methinks.)

The good news is that the lymphocytes (both the bad and the good) do indeed continue to decline, as the graph below continues to show:

Well, if you've been reading carefully so far (and you are to be commended if you are still able to follow along with me OK - <g.), and are trying to visualize what the graph might continue to show during my treatment, you maybe are beginning to realize one of the conundrums of CLL - it is essentially ~impossible~ to actually ~cure~ a person of CLL, short of the person undergoing a very successful stem cell transplant (i.e., a bone marrow transplant).

You see, I am taking drugs that are known to kill white blood cells (one of which even targets just the lymphocytes), and yet ~none~ of these drugs can single out just ~leukemic~ lymphocytes - they are quite unfortunately equipped to kill the healthy as well as the leukemic lymphocytes, and it should therefore be obvious that it is not really plausible to kill ~every~ lymphocyte in my body in a futile attempt to destroy ~every~ last CLL cell in the process. (In fact, if we were able to magically reduce my lymphocytes to just one cell, the odds are that the survivor would likely still be a leukemic cell.)

However, despite the above somewhat gloomy picture, we ~also~ do have to realize that it is ~still~ in my best interest to reduce my CLL cells as much as possible, whether I elect to eventually submit to a stem cell transplant or not. That is to say, keeping CLL at bay is ~still~ a useful goal...

Categories: Leukemia