I have been remiss in my journal updates so I will give the monster one. Thanks to all those who emailed me directly wondering what gives!
Here is the skinny from the marrow tests and the next steps. The biopsy showed a 50% reduction in the leukemia cells down to 23% of the cell blasts are the diseased ones. This is decent news. It could have gone the other way or stayed the same. Dr. Jones feels this is the Gleevec and some Graft VS Tumor effect although there is no physical evidence of GVHD (rash, elevated liver enzymes). I had a skin biopsy from my chest which showed no detectable Graft VS Host Disease as well. If it was positive, then we would have stayed the course with the Gleevec only. Since it was negative, I started taking shots of Interferon; a naturally occurring protein in the body that is part of the immunological cascade (cytokines, etc. for those remembering biology). So you ask … wassup with the Interferon? There have been some promising results in Germany published this year that Dr. Jones concurs with and is following. Here is the abstract of the article. It is available at Nature for a fee…the cost of science.
Efficacy and safety of Gleevec in combination with interferon-alpha (IFN-alpha) in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL)
Gleevec has marked antileukemic activity in advanced Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL), but secondary resistance develops rapidly, reflecting the limitations of single-agent therapy. Experimental data suggest that interferon- (IFN-alpha) enhances the antileukemic activity of Gleevec. We therefore examined combined Gleevec and low-dose IFN-alpha in six patients with Ph+ALL who were ineligible for stem cell transplantation. All patients had received Gleevec for 0.5-4.8 months prior to IFN-alpha, for relapsed (n=3) or refractory (n=1) Ph+ALL or as an alternative to chemotherapy following severe treatment-related toxicity (n=2). Five patients were in hematologic remission (CR) with minimal residual disease (MRD+), one patient was refractory to Gleevec. Four of the five MRD+ patients are alive in CR after a median treatment duration of 20 (11-21) months. Two of these patients are in continuous CR 21 months after Gleevec was initiated, while the other two patients experienced an isolated meningeal relapse that was successfully treated with additional intrathecal chemotherapy. Sustained molecular remissions were achieved in three patients and are ongoing 13 and 10.5 months after central nervous system (CNS) relapse and 6 months after starting concurrent IFN-alpha and Gleevec, respectively. Marrow relapse occurred in one of the five MRD+ patients. Combination treatment was associated with a complete marrow response of 5 months duration in the Gleevec-refractory patient. Gleevec combined with low-dose IFN-alpha may achieve prolonged hematologic and molecular remissions in a subset of patients with advanced Ph+ALL, who are not candidates for allogeneic SCT. CNS prophylaxis is necessary and may enhance the antileukemic activity of Gleevec and IFN-alpha.
What is interesting is that the above patients did not have transplants, they were relying on there own immune system to get stimulated by the Interferon and attack the leukemia that presents itself more prominently because of the Gleevec. So, as I view it, I already should have a fired up, donated immune system that just needs a little kick in the butt. Fingers crossed as usual.
I visit Hopkins once a week now that I have been officially discharged from the PROGRAM. Marcy and I feel like we are flying by the seat of our pants. We are well trained now so we should do all right. The worst thing now is my counts are next to zero so I am very susceptible to infection. Dr. Jones is much more cavalier regarding this then the ladies of IPOP. We are going to hang out somewhere in the middle with regards to safety and such. I am hoping to hit my company holiday party which does not offend any of the religions that are currently praying for me.
What have we been up to? The first week of interferon was tough…flu like symptoms and bad nausea the next day (the shots are M W F ). We went to Ocean City, MD with my father and Kathy. They scored a nice 2 bedroom condo with a den. Cool with the kids and all. For those in the OC know…it is the festival of lights now—a profoundly, cheesy spectacle of trailer park Christmas decorations. Amazingly, a huge money maker for the town…not sure what it says about the visitors. Things went pretty well with the kids, my parents were out of control, however.
This week we jack up the dosage of interferon. Hopefully, the bad flu like crap I had does not rear its head again. We hit Hopkins on Wed. for some blood work and then Dr. Jones on Thursday and possibly blood and platelets.
Sorry for the long post but it has been a few weeks and wanted to get all caught up and stop those people emailing me wanting the juicy details they have come to expect..
By the way, I think I am officially Getting-My-Eat-On according to Marcy. It is about time. Personally, I think I have a ways to go yet.
Dear Dr. Galloway,
Glad to hear the internship is coming along and you are acquiring the necessary background for your medical degree. I stopped by the Red Cross last week for another platelet donation, but ran into a problem: they said my iron count was too low to donate --- only 31. (31 "what" I'm not sure exactly.) The minimum for donating whole blood or platelets is 38. The funny thing is I had a blood test as part of an overall physical about a week before this, and the iron was 42...then again a few days after the test, to see if I was anemic, and it was still 42. These were blood samples drawn from the vein, a test tube full. Apparently, with the RC method, after the finger is pricked, it's possible to dilute the sample by squeezing the finger so hard that a lot of fluid is forced out of the tissues along with the blood sample. That waters down the test and makes it look like an iron deficiency. I discussed this with the RC and they shrugged. They have no remedy, and are willing to accept that they turn away healthy donors due to inaccurate testing. Oh, well...at least I didn't have to sit through another terrible movie.