Update on how things are going.

Hello everybody,

I just wanted to send a quick update on what's going on with me lately.

First of all, I'm really doing pretty well. I feel, for the most part, normal and am working four days a week in the clinic and am starting to do a little Labor and Delivery work again, for the meanwhile.

Many, but not all of you, know that after testing my siblings we have found that they all match another sibling but nobody matches me, so a bone marrow transplant will not be an option unless we end up looking in a national registry or something.

Plan B is to start some chemotherapy soon. In past years chemotherapy wasn't even considered until one's white count was over about 100,000 (normal being about 10,000). My white count has been steadily climbing since we found I had this disease, but is still "only" 43,000 as of last week.

But there are some new chemotherapies available, the most interesting being the new monoclonal antibodies that selectively attack the abnormal cells, sparing the normal ones. We're going to start therapy on July 22 with a combination of these monoclonal antibodies (called Rituxan) and a new chemotherapeutic drug, fludaribine, and a standard drug, cytoxan. The combination is getting some great reviews from M. D. Anderson and they've found a high percentage of complete remission, at least in relatively short (18 month) follow-up studies. It seems to work best in previously untreated patients with low-grade disease, which definition I fit perfectly.

So I'm actually looking forward to getting started on this regimen. But before we start infusing toxic substances into my bloodstream. Kathy and I are taking a trip to Germany starting next week. We'll be going to a number of places we've never been before. And thanks to upgrade coupons and frequent flier miles, we're going first/business class both ways! We're really looking forward to it.

That's about all for now. We'll keep you updated as things progress.

Later,

Dave

CLL website

Hi Doug,

Thanks for info; I've actually been spending a fair amount of time looking at the pages, trying to decide among my options.

There seem to be a great deal of things coming up at the same time, and more in development. And, it seems that it makes no real difference in which order you try them.

I think we're going to go the Rituxin/fludarabine/cytoxan route first, as is being done at M. D. Anderson with some apparently great results.The side effects seem to be minimal for most folks. Then, if need be, there are several (actually 40-50) new monoclonal antibodies being developed. Some folks are suggesting the protocol above, with a second round of a different monoclonal antibody to "clean things up." The antisense sounds extremely promising as well. I just read about it last night for the first time. I'm going to look into it a bit more before my next appointment to see what Brian makes of it.

I'm really doing quite well now. If they didn't tell me I was sick I wouldn't know I was. I'm continuing to work a four day week and no nights. I'm actually volunteering for a few weekend days on L&D since I now haven't delivered a baby in a few months. You can't call yourself an obstetrician if you don't "get wet" occasionally, as we say in the business.

Was I correct? Did Jen win the pool? She'll be thrilled! Actually, Dan won the pool...now he knows he has a matching kidney out there!

Later,

Dave

Message to Bob

Hi Bob,

Thanks for your note. I appreciate your thoughts, and I also appreciate the fact that it's hard to figure out what to say about my condition. Get well soon??

I'm actually doing pretty well right now. After the initial illness finally cleared, I began feeling normal again. I've been significantly depressed at times (probably a normal reaction) which makes it hard for me to sleep very well, but otherwise Kathy and I are both doing okay.

I'll be seeing my doc again in a couple of weeks. We're going to discuss the next step in my therapy; to treat or not to treat! He's recommended a combination of chemo and monoclonal antibodies, the newest kid on the block. They're getting about 60% complete remission rates with this new combination. We'll see if I can successfully get into the remission group with these kinds of odds, after missing out on the should-have-been sure odds of getting a donor match with a sibling! If I can't get better with that treatment, there are any number of new possibilities on the horizon, currently in clinical trials.

I guess the good news for Deb is that she's off the hook for a kidney for Dan, and Doug's on the hook!

That's all for now. Hope to see you guys in August, but I really don't know if we'll be travelling at that time; I may be undergoing my therapy during that time.

Oh, yeah. Before we start any therapy, we're going on our long-planned trip to Germany later this month--business/first class, all the way, thanks to coupons we got after last year's fiasco. We're leaving on the 16th and will be travelling to several places in northern and old east Germany where we've never been before: Quedlinburg, Goslar, Fritzlar and Hamlin. I'm really looking forward to the trip.

Dave

"Schnack, Bob" wrote:

Dave (and Kathy) -- I know I (and Kelsey) been "silent" by email about your leukemia. I just haven't known what to say, and I don't want you to think that we don't care or don't have concern. We think of you often and hope for the best results from whatever therapies you decide to go with. And as I'm sure you know, Deb, Kelsey and I would do ANYTHING we can to assist or help out. Bob