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More of the Same...or Not

Posted by Frederick Wasti
Sep 11 2012

I continue to keep "plugging along" in Part B of my Dana-Farber clinical trial. On the first day of each 28-day cycle I receive an infusion of Ofatumumab (an "old friend" from Part A) and an injection of Alemtuzumab (new for Part B). On all the other days I receive just a "simple" Alemtuzumab injection. (Of course, every day's drugs are preceded by multiple pre-medications.) For Part B, we head into Boston and back three days every week, each Monday, Wednesday, and Friday (although last week, because of the Labor Day holiday on Monday, we made the trip on a Tuesday-Thursday-Saturday schedule).

Although my blood was drawn and tested every day we were at D-F during the first month of Part B, the blood is now (and for the rest of Part B) tested only on Mondays. However, after some rather drastic changes in my white blood cells at the very beginning of Part B, blood tests over the last several weeks have been pretty "boring". But it has not always been so:

Taking a look at how the percentages of my lymphocytes and neutrophils have changed during the clinical trial...

...shows that Part A (the area to the left of the vertical green line) caused the percentage of lymphocytes (the red line) to gradually but definitely decline while the percentage of neutrophils (the blue line) correspondingly increased. The same graph also shows that, in Part B (beginning with that green line, which represents July 9th, the first day of Part B), the slopes immediately and dramatically changed, until very quickly the lymphocytes approached zero and the neutrophils reached the upper nineties, whereupon the curves did then more or less level off. However, it is just that leveling off that has caused all of the recent blood tests to all seem, well, "boring".

Similarly, taking a look at changes in the total leukocyte count during the trial...

...shows that the total white cells count went from the upper fifties (in thousands of cells per microliter) down to about 5 or so (which is actually within the normal range) during Part A, and then the count has stayed there (more or less) throughout Part B.

However, in regard to being "bored" by all of the recent weekly blood test results, I do want to point out the following:

1. These blood test results may seem to be "boring", but they are also extremely gratifying, in that my lymphocytes have been ~greatly~ reduced (both the bad ones and, unfortunately, the good ones, too), while the all-important neutrophils have been allowed to rebound to normal numbers, and the total number of white blood cells has become quite normal (maybe even "low normal"). If anyone had told me that, after the four months of Part A and just a week or two of Part B, my white cell count would be normal, that my neutrophil count would be normal, and that my lymphocytes (including, of course, the leukemic lymphocytes) would be reduced to only 1% or 2% of my total while cell count, I would not have believed it - but that is just what has happened. (Amazing!)

2. It is well worth remembering that, at this point, since the above graphs illustrate all ~good~ news, ~any~ significant changes in the graphs would likely be ~bad~ changes, so, in that context, "boring" is certainly a ~good~ sign - <grin>.

3. These blood test results cannot show just what is going on with the proportions of the good (i.e., the normal, non-leukemic) lymphocytes and the bad (i.e., the cancerous) lymphocytes. In a sense, blood tests are really only looking at the tip of the proverbial iceberg. However, I am scheduled to have a bone marrow biopsy (which can provide information on what is going on with the lymphocytes and their production in my bone marrow) and a CT scan (which can provide information on the size of my spleen and lymph nodes, the "favorite hiding places" of leukemic lymphocytes) in just a few weeks (at the half-way point of Part B).

So, while the weekly blood test results may offer "more of the same" on Monday after Monday right now, hopefully whatever else might be going on within my circulatory and lymphatic systems, which cannot easily be detected by simple blood tests, but which might be observed in the upcoming CT scan and BMB, will all turn out to be positive. (After all, why go through the rest of Part B if nothing else further were going on, right?) Please stay tuned...

Categories: Leukemia