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Final Week of Methylprednisolone (#1)

Posted by Frederick Wasti
Jun 13 2012

Today was the first of three days of my final week of Methylprednisolone at Dana-Farber. You may recall that the four 28-day cycles of Part A of the clinical trial involved receiving Ofatumumab every Wednesday, and HDMP (high-dose Methylprednisolone) for three days (Wednesday, Thursday, and Friday) of each first week of each 28-day cycle. Well, today, tomorrow, and Friday are the three days of Cycle 4 of Part A, so these are the last three days for Methylprednisolone (or maybe four, or seven, or seventeen - the effects of Methylprednisolone last for many, many days after the infusions stop...).

[Looking ahead to the six 28-day cycles of Part B, I will no longer be receiving Methylprednisolone at all, and instead will be receiving less frequent (once per cycle) infusions of Ofatumumab, but quite frequent (three times per week) subcutaneous injections of Alemtuzumab).]

Today was not just a normal "first day of the cycle", however. The first inkling that it might be different occurred last night, when we received a phone call from D-F Scheduling, to learn that our 7:30 start was to be changed to 9:00. (No reason was given, and no reason was asked for.) Today we found out that D-F had run out of Ofatumumab, but would obtain some this morning for me. The D-F Pharmacy Department said "by 10:00". My nurse practitioner (who gave me a physical exam first thing this morning) said "maybe by 11:00". Melissa Houston, my superb infusion nurse, said, "well, maybe by 12:00". Well, some Ofatumumab did arrive from Mass General Hospital a bit after 12:00, but then we had to wait a little longer because the D-F Pharmacy Department had to prepare my dose of it. So, I guess today's infusions probably started some time after 12:30.

Obviously, with such a late start, everything got backed up quite a bit, since I had to take an infusion of HDMP (after the acetaminophen and Benadryl pills), and then an infusion of Ofatumumab (and the latter infusion, just by itself, takes about four hours). The bottom line is that we didn't get away from D-F today until about 6:30.

However, since the day was longer than usual, but did not cost us any more, I guess "we got ~more~ for our money" this time - <grin>.

As for the blood test results, the total white cell count, and both the absolute counts and relative proportions of both lymphocytes and neutrophils, were all about the same as last week. (Actually, they were very slightly worse, but the differences seem insignificant - "nothin' ta worry 'bout".):

However, I've also been watching the platelet counts over the last few months, too, since platelets are important for proper clotting of blood, and are often impacted by CLL:

The good news shown here is that, while it does seem as if the platelet count does certainly fluctuate a lot from test to test, the overall trend, while downhill before starting treatment, has now been heading uphill ever since. A platelet count of less than, say, 100, is not only important because it can result in poor clotting ability, but is also an indicator that rampant CLL growth may be crowding out platelet production in the bone marrow. So, the above platelet trend is indeed gratifying.

[Of course, despite any previous possible loss in clotting ability, I did have just "one clot too many" during this time period, resulting in my "surprise" pulmonary embolism, for which I am still "merrily" injecting myself with Fondaparinux each morning - <grin>.]

Well, we're off to D-F for tomorrow and Friday mornings, for the final two days of HDMP. YAY !!!

Categories: Leukemia