"I think we should just declare victory and be done with the Fludarabine," is what the doctor said this morning. Dave's white blood cell counts were (once again) too low for chemo, even too low for Rituxan. It's been almost two months since he had his last (fifth) round of Fludarabine. Since that time, he's had a severe bout with Autoimmune Hemolytic Anemia, but that seems to have slowed, maybe stopped - the doc thinks it was the Rituxan that put the brakes on the anemia (plus wiped out a good chunk of white blood cells.)
So the new plan is to continue with the weekly blood tests and plan to give him Rituxan now and then, when his blood levels allow it. She didn't actually say, "now and then" - she proposed some complicated schedule that I didn't bother to write down because I'm 99 percent certain that it'll change before we get to it. The bottom line is that, unless some unexpected disaster happens in the next few weeks, Dave will get his next dose of Rituxan on December 5th. It could take months for his red blood cells to get near normal.
But he has an amazing capacity for adapting to the anemia. When we were in Los Angeles recently, he walked all over town with me, including up the steps at Angel's Flight (that's him, above, watching the parrots half-way up the hill.) We both took a lot of photos in L.A. Mine are up on my Flickr page now; Dave is still scanning his film and will probably post something later today. Dave's also writing for the new group blog, Bay Area Artquake!
I probably won't be updating this spot until Dave's next treatment (December 5th.) Meanwhile you can keep up with us at our usual spots:
Dave's Photo Blog
Dave's Flickr Page
Anna's Art Blog
Anna's Flickr Page
3 comments:
You might check into rituximab maintenance. This involves using low or moderate doses of rituximab on a regular basis. A number of recent papers have suggested that longevity in enhanced in the population which received maintenance rituximab.
Cancer. 2007 Nov 12; [Epub ahead of print]
Consolidation and maintenance immunotherapy with rituximab improve clinical outcome in patients with B-cell chronic lymphocytic leukemia.Del Poeta G, Del Principe MI, Buccisano F, Maurillo L, Capelli G, Luciano F, Pio Perrotti A, Degan M, Venditti A, de Fabritiis P, Gattei V, Amadori S.
Department of Hematology, University “Tor Vergata,” S. Eugenio Hospital, Rome, Italy.
BACKGROUND.: Rituximab in sequential combination with fludarabine (Flu) allowed patients with B-cell chronic lymphocytic leukemia (B-CLL) to achieve higher remission rates and longer response duration.
Based on their recent experience in indolent non-Hodgkin lymphomas, in this study, the authors attempted to demonstrate whether consolidation/maintenance therapy with rituximab could prolong the response duration in this patient population.
METHODS.: This Phase II study was based on a consolidation/maintenance therapy with rituximab for patients in complete remission (CR) or partial remission (PR) who were positive for minimal residual disease (MRD), as determined by flow cytometry. Seventy-five symptomatic, untreated patients with B-CLL received 6 monthly cycles of Flu (25 mg/m(2) for 5 days) followed by 4 weekly doses of rituximab (375 mg/m(2)). Then, 28 patients who were positive for MRD were consolidated with 4 monthly cycles of rituximab (375 mg/m(2)) followed by 12 monthly low doses of rituximab (150 mg/m(2)).
RESULTS.: Based on National Cancer Institute criteria, 61 of 75 patients (81%) achieved a CR, 10 of 75 patients (13%) had a PR, and 4 of 75 patients (5%) had either no response or disease progression. MRD-positive patients in CR or PR who received consolidation therapy (n = 28 patients) had a significantly longer response duration (87% vs 32% at 5 years; P = .001) compared with a subset of patients who did not receive consolidation therapy (n = 18 patients). All patients experienced a long progression-free survival from the end of induction treatment (73% at 5 years). It was noteworthy that, within the subset of ZAP-70-positive patients, MRD-positive, consolidated patients (n = 12 patients) had a significantly longer response duration (69% vs 0% at 2.6 years; P = .007) compared with MRD-positive, unconsolidated patients (n = 11 patients).
CONCLUSIONS.: The addition of a consolidation and maintenance therapy withrituximab prolonged response duration significantly in patients with MRD-positive B-CLL. Cancer 2008. (c) 2007 American Cancer Society.
PMID: 17999417 [PubMed - as supplied by publisher]
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www.pubmed.com Search on chronic lymphocytic leukemia. Or go to CLLResearch.groups.yahoo.com
waHOOOOOO. I detect a video night on the horizon!
The first commenter has an interesting idea, especially since Rituxan is used to treat AIHA. Fludarabine, as you probably know, can trigger it, even in combination therapy such as FR, especially if a patient is already hemolyzing. As a fellow CLLer with AIHA, I had to grapple with deciding what to do when it came to treating the AIHA and CLL. I intend to post about some of the treatment regimen issues in the near future; suffice it to say that I wrote to Clive Zent, who is the expert on autoimmune disorders and CLL at the Mayo Clinic and author of a recent paper on the same, and in his view it is "very risky" to use fludarabine even in combination therapy when a patient is undegoing active hemolysis.
Good luck with the Rituxan and the recovery of the red counts. My HGB and HCT were almost exactly where Dave's were as you described in your August post, so I know firsthand what life is like in those circumstances.
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