Saturday, November 28, 2015

Despite my CLL, I have almost Normal Lab as I head to ASH next week

I am back from a quick trip to Ohio State University, Columbus, Ohio to see Dr. Byrd for my ibrutinib trial with good news.

My clinical exam was normal - no enlarged nodes or liver (my spleen has been long gone, removed more that 8 years ago in an unsuccessful attempt to raise my low platelets). The rest of physical exam was normal.

But what about the lab you ask- many of us with CLL may look good, but it is often our labs that are wonky.

Not mine. No anemia and basically normal platelet and normal neutrophil counts. The total lymphocyte count that includes our cancerous B cells was even a bit lower than normal.

So if my total lymphs are low, then my cancerous CLL cells must also be low. And that is very good news.

I won't know the actual number of lymphocytes that are part of my bad monoclonal clone until the fancy flow cytometry come back in a few weeks. That test tells what percent of my lymphocytes are cancerous.

And then even later, I will learn the results of the important research test that looks deeply at my cells for the common mutations that could make my cells resistant to ibrutinib. A negative test (no significant mutations) bodes well for the ibrutinib to continue to work its magic, a positive finding  suggest a relapse may be in the offing.

This is important because in high risk patients such as yours truly with an unstable cell type (17p deletion and complex karyotype) there is a small but real annual rate of relapse on ibrutinib. This test looks into the future and projects who at risk.

That's why I am always pushing for a second step beyond monotherapy with a signal blocker (ibrutinib and idelalisib). We need a one-two knock out punch.

My blood chemistries are mostly good too, though one very old school, inexpensive marker is abnormal. My LDH (Lactic DeHydrogenase) or LD has been slowly climbing.

This is a very nonspecific test as LDH is a ubiquitous enzyme found in most cells (and in bacteria too) that can be a marker of all kinds of cell destruction (heart, blood, lung, liver and even brain are common sources) or certain serious infections or certain types of tumor proliferation or nothing.

My LDH was been slowly trending up for a year and is now slightly above normal. Dr. Byrd is not worried as the much more specific markers of disease are all reassuring.

When we have CLL, there is always some fly in the ointment, some minor distraction, some nagging uncertainty.

Life rolls on and life is good. With CLL, we are never dealt royal flush, never have a sure thing, but when we have a darn good hand we need to celebrate and enjoy.

So I am off to ASH 2015, the largest and most important hematology meeting of the year, next week in Orlando. I am fighting a cold and tenosynovitis of my right thumb (think pain with using your thumb), but I am not going to let such trivialities slow me down, though I am going to take a short nap as soon as this post is online. Sleep- sweet nature's balm.

ASH will be crazy for sure because as it will be nonstop interviews and meeting and abstracts and press conferences.

I go wearing at least 5 different hats:
  1. A patient who want to know the latest about CLL as I am not cured
  2. An advocate pushing to get better trial design and better access to the best possible therapies
  3. A reporter bringing the latest news from the 100s of abstracts and oral presentations, press conferences and interviews with the experts
  4. The medical director of a nonprofit corporation meeting with other nonprofits and industry to find ways to mutually support our efforts to get the word out and help patients
  5. A doctor who directly helps care for patients with CLL (with the heavy lifting being done by their hematologists)
Someday soon I also hope go as a researcher or as a speaker as I did at iwCLL where I spoke on how to improve access to expensive drugs in front of 500 plus doctors. That will take more work and effort, but I have plans.

I also am getting used to the tables being turned and having the microphone in my face as I am now the occasional interviewee and not the interviewer.

And I go as friend. After so many years and conferences, many of the top CLL researchers have become friends, members of our scientific advisory board and active in our nonprofit CLL Society.

There is not too big number of patients and advocates in attendance, but I will connect with some of them there and at a related meeting for nonprofits in the blood cancer world that we will attend.

Much to share. All good.

Sign up for the CLL Society alerts here. It is where I am doing most of my writing these days and the alerts are the best way to keep up to date. We have been putting up new posts almost twice a week, so   it is the place for the latest CLL news. And our next newsletter will be out before the year's end

Finally, if you live in the LA area, please join us at City of Hope on Dec. 15 for a patient education forum and the possible launch of a new support group. Details are here.

Stay strong.

We are all in this together.

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Blogger Judy Cleri said...

Wonderful news Dr. K.

November 29, 2015 at 9:15 AM  
Blogger Unknown said...

I'm exhausted just reading about your lineup of activity. You are a remarkable and generous warrior for the cause. Glad for your basically good chemistry results.

November 29, 2015 at 2:56 PM  
Anonymous Anonymous said...

I'd be interested in what the general opinion is as to when ibrutinib will be approved for front line treatment.

john liston

November 29, 2015 at 4:14 PM  
Anonymous Anonymous said...

Dr. Koffman, may the amount of work you do on our behalf translate into tangible results. I'm so glad you are doing well on Ibrutinib.

November 30, 2015 at 8:23 AM  
Anonymous Anonymous said...

Glad to hear almost all lab tests normal. How about Immunoglobulins? Don't they always stay low in advanced CLL? Or, did ibrutinib fix them, too?

December 23, 2015 at 10:13 AM  

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