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(sort of) Just Another Ofatumumab Day (?)

Posted by Frederick Wasti
Jul 09 2012

Today was the first day of Part B of my clinical trial at Dana-Farber. It was scheduled to be a long day, where I was to be given (in the following order) 50 mg of Benadryl, two 500 mg Tylenol tablets, 30 mg of Alemtuzumab, 50 mg of Methylprednisolone, and 1,000 mg of Ofatumumab.

The Benadryl, Tylenol, and Methylprednisolone are given in Part B simply as "pre-conditioners", for helping to make the actual anti-leukemia drugs, Alemtuzumab and Ofatumumab, easier to tolerate, and the dosages and methods of administration for Tylenol, Methylprednisolone, and Ofatumumab are all the same as in Part A. However:

The 50 mg of Benadryl was given to me today by infusion, rather than in pill form, and it was the full dose of 50 mg, too. This seemed to be a case of "deja vu all over again", since 50 mg of Benadryl by infusion is what I first received back at the beginning of Part A just before being given Ofatumumab. However, after finding that I became a total zombie from that dosage and administration method, the dosage was cut to 25 mg after a couple of weeks, and then a switch was made to oral administration instead of infusion after a few more weeks, in order to allow me to be perhaps somewhat more responsive to reality. However, at least for today (and possibly for next Wednesday, as well) it was recommended that I go back to the 50 mg by infusion protocol, since I was starting a new drug, Alemtuzumab, and it was not known (yet) how I would tolerate it. And, not only were the dosage and method of administration "deja vu", the effects were, too - I was, once again, more like a "Walking Dead" actor for a few hours than I had been for most of Part A.

Alemtuzumab ("al-em-TOO-zoo-mab") (a.k.a. "Campath") is a brand spankin' new drug for me. It is another monoclonal antibody (making it, technically, not an actual chemotherapy drug at all, which is nice). Ii is similar in action to Ofatumumab, in that it targets specific molecules on the surface of lymphocyte cells, but it is also different, in that the molecule that it attacks is found on both B-lymphocytes and T-lymphocytes, so that it kills a larger variety of lymphocytes than does Ofatumumab, which kills only B-lymphocytes (and, in CLL, it is only the B-lymphocytes that are leukemic). Also significantly, while Ofatumumab is better at attacking CLL cells in the blood, Alemtuzumab is better at attacking CLL cells in the bone marrow.

Unfortunately, Alemtuzumab is notorious for not being quite as tolerable as are some of the other monoclonal antibodies (e.g., Dr. Yamin, my hematologist/oncologist at Jordan Hospital in Plymouth, refers to it as "nasty stuff"). In fact, it used to be administered only by infusion into a vein, but is now usually given by injection under the skin, since it seems to cause fewer and less "dramatic" side effects in that way.

Well, the good news I have for today is that I have not seen any noticeable reaction to Alemtuzumab that I can distinguish as being different from, or in addition to, any that I could attribute to Benadryl and/or Ofatumumab. So, today seems (sort of) like "just another Ofatumumab day", and that is good news ~indeed~! (<smile>)

[Edit, July 10th AM - it is clear that I had a bit of a "heavy head" last evening that was probably a bit stronger than I had experienced the last few times I had Ofatumumab, and I also had a bit of trouble going to sleep (which is unusual for me), and I am assuming that these may be due to the new Alemtuzumab.]

[I still have to discuss last Friday's radiologic, blood, and marrow tests, and our chat with Dr. Fisher, but I wanted to get the above description of today's treatment online first.]

Categories: Leukemia