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The Latest Medical News

Posted by Frederick Wasti
Jul 10 2013

On Monday, 7/8/2013, we spent a long day at Dana-Farber Cancer Institute in Boston. While it is true that, in Part C of my clinical trial, visits are infrequent enough (once every other week) to be merciful, it is also true that, on every fourth visit (i.e., once every eight weeks), Diane and I get to spend most of the day at D-F due to a long infusion of Ofatumumab at that interval. However, as I am writing this, I certainly am not complaining about the treatment protocol that has allowed me to live this far, but I am merely unemotionally stating a fact, that's all.

The blood test results from Monday were basically "more of the same", and I'm certainly not complaining about that, either. My total white blood cell count remains within the normal range:

This is because the Part C treatment in my clinical trial, which was termed as "Maintenance", does seem to be adequate to ~maintain~ the beneficial but unnatural imbalance in my differential white cell counts:

This imbalance is due to my lymphocytes (leukemic as well as normal) still being greatly suppressed -- although lymphocytes would naturally make up a quarter or even a third of my white cell total, and although they did (due to the growth of leukemic lymphocytes) actually make up over four-fifths of my total white cells when my treatment started, they now represent only 1% or 2% or so of my white cells:

The absolute number of lymphocytes,...

...has been kept unnaturally low due to the combination of Ofatumumab (Arzerra) (which attacks lymphocytes primarily in the lymphatic system and in the bloodstream) and Alemtuzumab (Campath) (which attacks lymphocytes mostly in the marrow). This two-pronged "maintenance" comes at a price, of course:

While most of the cells in my body are spared serious consequences, all the lymphocytes, whether leukemic or normal, are "punished" for the leukemic deeds of a few. As a result, my immune system is still greatly compromised, even as I may seem to appear to be more or less "healthy". Before treatment my immune system was inefficient, due not only to the huge number of immature CLL cells which performed poorly, but due also to the fact that they were crowding out all of the other essential cells from my bone marrow. Now, instead, my immunity is compromised mostly because of the fact that lymphocytes are supposed to be available in sufficient quantity to fight off infections and, in my case, there are just not too many of them left. (This is perhaps an overly simplified explanation of the situation, but that's basically the story.)

As an example of some (fortunately not extensive) collateral damage resulting from my treatment, I think it is interesting to look at how the absolute number of monocytes have varied over time:

While the number of monocytes at the start of treatment was not abnormally low, it can be seen from the above graph that they did decline somewhat during Part A, but that they really "took a hit" during Part B because of the intensive combination of Ofatumumab and Campath. However, note that, right at the start of Part C, when the Ofa and Campath treatments became spread out by quite a bit, the monocytes had a chance to "bounce back" somewhat -- while my monocytes are still rather few in number here in Part C, they are not quite as depleted as they had been in Part B.

So, because of my compromised immune system, I still have to take several medications each day to ward off potential invaders - Mepron liquid twice a day to defend against bacteria, Acyclovir pills twice each day to protect against viruses, and Noxafil liquid three times a day (once with each meal) to guard against fungi. And, I am assuming that I will have to continue taking such medications for some time to come, not only during the remaining time of the clinical trial, but also when I return to Watch and Wait status afterwards, because I will still have a compromised immune system. Oh well...

However, I do have some good news to report on the number of medicines I have to take routinely. You may recall that, due to the hives I developed during the second week of Part B (likely due to my body protesting the three times per week Campath treatments), I had to start taking additional anti-allergy medications every evening of every day - Benadryl, Zyrtec, and Acetaminophen (Tylenol). (I described the hives - and the meds to ward them - off in a blog entry from 7/23/2012, "Yikes !!! Hives !!!".)

So, I'd been taking those three meds, 50 mg of Benadryl, 10 mg of Zyrtec, and 650 mg of Tylenol, before bedtime every day for almost a year now. However, after meeting with Dr. Fisher on Monday morning, I was told that I could now "dispense with dispensing them", since I do seem to be tolerating Campath adequately. Furthermore, I will no longer have to be given Benadryl and Tylenol as pre-meds before my Campath injections each time I visit D-F during the rest of Part C. (Of course, all of this would all change if it were found that I did in fact need their anti-allergic protections after all.) This has made my evening meds routine a lot simpler -- rather than having to take five pills (two Benadryl, one Zyrtec, one Tylenol, and one Acyclovir) and one liquid (Mepron) each evening, I now need to take only an Acyclovir pill and some "delicious" Mepron liquid.

Finally, back on Tuesday of last week, 7/2/2013, Diane and I paid a visit to Brigham and Women's Hospital to meet with a rheumatologist there about my arthritis. However, I'll leave my report on the latest arthritis news for another blog entry...

Categories: Leukemia