Thursday, July 25, 2002

Still doing okay; more about Rituxan

Dave's Great Adventure
Chapter 1, Verse 3
July 25, 2002

Well, the third day has come and gone without any problems, thus far.

Yesterday I started out the day sleeping in a bit late, getting up about 8:30. Kathy was waiting for me downstairs and hadn't gotten ready to go to her swimming aerobics class yet (which starts at 9:00) because she hadn't wanted to bother me. I had to convince her I'd be okay and that she could go to her class, which she really enjoys. So I got her on her way and had some breakfast. Then, I went out and worked on the backyard.

We have lovely aspen trees in our yards. They grow quickly and give great shade and privacy, but the damned things send out shallow roots all over the place and these send up shoots wherever conditions are favorable for growth, like in one's grass. The back yard has lots of these shoots. I've mowed them down repeatedly but they keep coming back, so yesterday, since I was still feeling well, I attacked them with a knife, in order to try to get to the roots. I hacked down a small grove of the silly things. (I feel I must explain some of these side issues in some detail, because, though my Colorado friends know what this is all about, the messages are also going to Georgia, Oklahoma, New Mexico, Montana, Texas, South Carolina, California and to friends in Germany, too)

So after I finished the lawn work I took a bath and wrote a letter to you guys. And then my mind is starting to find things to worry about. "How come you feel so normal? Is the stuff working?" The chemo I'm taking does not always work, of course, but it works most of the time, at least for a while. So I start wondering if I'll be the exception again, like when I got the leukemia in the first place, or like when none of my sibs matched me in marrow typing. I'm a worrier, always have been. Well, I thought I might beat the odds again, and bought a Lotto ticket a couple of days ago; hey, I got a $3.00 winner! It's a start.

After pre-loading with a lot of fluids yesterday we went in for round three of the Fludara and Cytoxin. I again was premedicated with the Anzemet (great stuff) and the dexamethasone and they plugged in the IV. Away we went. Again, no problems at all, no symptoms, no nausea. I joked with my doc that I must be in the placebo control arm of the "study" since I continue to feel so normal. I read for the 90 minutes or so that the infusions took and then we left. It was too early this time to go for Mexican food, so we came home, watched the news and then went out for Wendy's burgers.

I continued to force fluids the rest of the evening, per my nurse's (and Kathy's) instructions and of, course, that made for a relatively restless night with frequent trips to the bathroom. I won't have to do that so much again until the next rounds of the chemo, but I still need to keep well-hydrated because of the allopurinol I'm still taking daily.

Today I don't feel quite so energetic as I had been feeling. I don't know whether it's just that I has a restless night or whether the poisons are finally kicking in. If the medications are finally kicking, so much the better. Maybe I'll stop worrying a little.

Let me tell you a bit more about the Rituxan and why we're going to use it. I mentioned earlier that it is a mouse (!) antibody against specific antigens or proteins on many leukemic cells. (I'll have to remember that as I trap and kill the little field mice that get into our basement every winter; their cousins may be helping me live longer)

The drug was just approved for use against lymphomas a very few years ago, about 1999. But since lymphomas and CLL cells carry many of the same antigens, it was thought that perhaps the drug would work on leukemic cells as well. So, over the last couple of years various organizations have been studying the use of the Rituxan alone or in combination with chemotherapy as a treatment for CLL. These studies have shown some pretty good response rates (partial or complete remission), much better than many standard drugs which often have less than a 20% response rate or so.

The best response was in a study from M. D. Anderson in Houston where they gave the Rituxan concurrently with the Fludara and Cytoxin. This was reported in a publication called "CLL--The Cutting Edge" in April 2002; right up to date. There the response rate was 90+ percent, an astounding rate (but this is still in a small study of about 130+ patients). Of these, about 66% had a complete response, or a normalization of the blood counts, and of the 66% complete responders, about half had no genetic evidence of disease at the end of the short, 18 month study. These are small numbers and the follow up is short as well, but it is very encouraging news in the study of a disease where there really is no know long-range cure yet. There were only two "early deaths" reported in this study, as opposed to the 25% mortality rate from bone marrow transplant, much better odds I think, at least in the short run.

So, that's where we're headed. The next thing I have to do is get a blood count in about 7-10 days, and see where my "Ralph" (low point, or nadir)* count is, the we get ready for round two, starting August 20th and going through the 23rd, our which will be our Thirty-Third wedding anniversary! What a way to celebrate!

(*For my German friends, I'm making a joke on the name of a Green politician in America named Ralph Nader, with whom I have very little in common politically).

And that's about all for today. I'll keep you updated on any changes in condition or plans as the days go by. Feels free to ask questions if anything I've said didn't make sense or was incomplete.

Until later,