Wednesday, August 22, 2007
Time to Start Rituxan
Dave, heading into Star Photo (616 Irving; 415-681-2445) to get his film developed. He stops by so often, he's on a first name basis with all the guys in there. He's still shooting up a storm, in spite of an anemia so severe that he gets light-headed if he stands up too quickly.
This was a long day at the clinic. As I suspected, his bloodwork yesterday was not good. The anemia was the worst it's ever been. On the other hand, his platelets and lymphs were slightly improved (not nearly enough, but at least they didn't get any worse.)
So it looks like he's stuck with Prednisone therapy for the foreseeable future (to slow the destruction of his red blood cells.) He's starting to get some muscle-wasting, but none of the other nasty side effects have surfaced.
After three months of Chemo, the Fludarabine/Mitoxantrone is really kicking his bone marrow but it's not doing a whole lot to the cancerous lymphocytes, so the new plan is to add Rituxan. Rituxan is a monoclonal antibody which specifically targets mature B Lymphocytes (as opposed to ordinary chemo which kills a lot of "innocent bystander" cells.) This is good news, in my opinion - I was hoping they would try Rituxan soon. But of course, Rituxan has its own sticky wickets, and the first one comes up tomorrow when Dave gets his first dose of Rituxan.
The infusion will take 6 hours (they told him to "pack a lunch.") Rituxan causes fairly serious allergic reactions in a lot of people, so Dave may need to be treated for that. Plus, the Rituxan is expected to kill the lymphocytes pretty quickly and when the dead lymphs start spilling toxins into his bloodstream, he'll be at risk for Tumor Lysis Syndrome.
Once he gets through the first dose, he'll be scheduled for repeat doses once a month, and then every 6 weeks or so, for . . . awhile (not sure how long - no point getting fixated on a long-term schedule, these days.)
But, back to the anemia. Next week Dave is scheduled for a blood transfusion - unless his RBCs manage to rally between now and then.
Blood work today:
WBC - 7.2
RBC - 1.57
Hemaglobin - 6.4
Hematocrit - 18.8
MCV - 120
Platelets - 139
Seg Neuts - 1%
Lymphs - 88%
Posted by Anna L. Conti at 3:31 PM