Still Running Up That Hill

My last blood test was two weeks ago and the results are mixed. On the positive side, all my red counts are now above the low end of normal and my neutrophils are higher than they were the day before I started treatment. This is good news which means the Cladribine must have had an effect on the hairy cells in my marrow. Unfortunately, all of my white counts (including the neutrophils) are still well below the low end of normal, which makes me a minor responder -- part of 5% of patients for whom Cladribine treatment does not result in a complete or partial remission.

The latest FACS results indicate that the level of hairies in my peripheral bloodstream is 0.25% (wrt mononuclear cells), so no change since late July. The binding capacity of my hairies for the anti-CD20 monoclonal antibody Rituximab (aka Rituxan) is still over 100k, which means the Rituxan should work well. Unless a miracle happens between now and my CBC and BMB in October, I will still have minimum residual disease (MRD) and undergo treatment with 8 cycles of Rituxan (once a week for 8 weeks), which Dr. K believes "may eradicate the disease."

I'm on cruise control now. Hopefully, the Cladribine has peeled away enough layers of the onion to let the Rituximab finish the job. The veins leading to my marrow that were once clogged with hairies (I compare it to hairy algae clogging the tubing in a fish tank) should be cleared out and ready to let the Rituximab into my marrow.

Here're my latest CBC plots:















I like the acceleration in the red counts. Maybe all that coffee and chamomile drinking helped after all...

I'm going back in tomorrow to have more blood drawn to see if they can clone my hairies for PCR before we start the Rituxan treatments. I'm not sure if this means none of the prior attempts worked or not. Maybe they just want to ensure that they have a "fresh" clone in case the chemo caused mutations or some sort of genetic natural selection in which the surviving hairies are somewhat altered from the general pre-chemo population of clones that were produced. The clones are used in the PCR process to detect 1 hairy cell from 1 million blood cells vice the current state of the art of 1 in 10,000.

If they get the cloning and PCR detection technique to work, it may lead to earlier detection and use of Rituxan as a standard therapy to attack the disease early on when tolerable doses of Rituxan alone can eradicate it. Of course there is always the argument that if the blood counts haven't been affected, there's no need to treate the disease, but if cure can be demonstrated, then this argument may need to be re-examined.