You knew it was only a matter of time before I had to use that corny title for a blogpost, but bear with me, it follows a coherent theme.
Other candidate titles for this post included:
Dirty Hairy
From Hairy to Eternity
The Good, The Bad, and The Hairy
Gone Today, Hairy Tomorrow
The Cells that Wouldn't Die
Protocol
and Hair We Go Again
Simply put: you take the good, you take the bad, you take 'em both and there you have the FACS of life...
The Good: The Rituxan treatments worked really well and as I wrote in my last post, the hairy cell burden in my May bone marrow biopsy was zero (although the bone marrow aspirate [liquid] showed 2.1% hairies). Likewise, I just had a complete blood count last week and my counts are at historical highs since diagnosis, so my marrow is continuing to rebound and keep me healthy.
The Bad: My FACS results from last week showed some hairies in the peripheral bloodstream (.02% of the peripheral blood monoclonal cells), but there are several reasons for why that may be.
The Theories:
#1: It's very possible that the few hairies which were bound with Rituxan but not completely killed via apoptosis or immune system attack, were undetectable in prior FACS tests due to the effects of the Rituxan covering the surface. Now that the Rituxan is flushing out of my system and coming unbound from the hairies, those cells are once again detectable.
#2: The cancer that wasn't killed by the Rituxan (some of the cells in the aspirate) are starting to proliferate again and seep into my peripheral bloodstream.
The analysis:
Usually the simple answer is the correct one (unfortunately #2 is the simplest), but we are sailing in uncharted territory right now, and there is plenty of time to perform more tests over the coming months and really get a feel for what is going on. Theory #1 is highly optimistic but still plausible, and it's still very possible that as my marrow rebuilds, my immune system will either keep the remaining HCL in-check or attack and destroy it. Time will tell.
What's next:
Given how well Rituxan worked the first time considering my HCL burden after Cladribine chemotherapy was still substantial, I believe I would benefit from a second round of Rituxan treatments if they are offered to me. The possibility of adapting the protocol accordingly for my cohort is being considered (the simultaneous chemo/Rituxan cohort is allowed two rounds of Rituxan, but my delayed Rituxan cohort is currently allowed only one).
In the meantime, I'm interested in seeing how my body will respond to the remaining hairies and feel that doing some more FACS tests to see if the burden increases or becomes undetectable again will help to substantiate or disprove theory #1. Over the next few months, we'll run some more FACS tests and see what happens. Let's hope my immune system kicks it.
Here's a slide show of my latest blood count results:
Since my last post in May, I've really been enjoying life. Taking lots of time to be with the family, a trip up to Hershey Park, and enjoying the weekends when the heat or rain doesn't make that impossible. It's been an incredibly happy time and given that the blood counts are continuing to improve, I really don't care about the few cells that were found in the peripheral bloodstream.
Other candidate titles for this post included:
Dirty Hairy
From Hairy to Eternity
The Good, The Bad, and The Hairy
Gone Today, Hairy Tomorrow
The Cells that Wouldn't Die
Protocol
and Hair We Go Again
Simply put: you take the good, you take the bad, you take 'em both and there you have the FACS of life...
The Good: The Rituxan treatments worked really well and as I wrote in my last post, the hairy cell burden in my May bone marrow biopsy was zero (although the bone marrow aspirate [liquid] showed 2.1% hairies). Likewise, I just had a complete blood count last week and my counts are at historical highs since diagnosis, so my marrow is continuing to rebound and keep me healthy.
The Bad: My FACS results from last week showed some hairies in the peripheral bloodstream (.02% of the peripheral blood monoclonal cells), but there are several reasons for why that may be.
The Theories:
#1: It's very possible that the few hairies which were bound with Rituxan but not completely killed via apoptosis or immune system attack, were undetectable in prior FACS tests due to the effects of the Rituxan covering the surface. Now that the Rituxan is flushing out of my system and coming unbound from the hairies, those cells are once again detectable.
#2: The cancer that wasn't killed by the Rituxan (some of the cells in the aspirate) are starting to proliferate again and seep into my peripheral bloodstream.
The analysis:
Usually the simple answer is the correct one (unfortunately #2 is the simplest), but we are sailing in uncharted territory right now, and there is plenty of time to perform more tests over the coming months and really get a feel for what is going on. Theory #1 is highly optimistic but still plausible, and it's still very possible that as my marrow rebuilds, my immune system will either keep the remaining HCL in-check or attack and destroy it. Time will tell.
What's next:
Given how well Rituxan worked the first time considering my HCL burden after Cladribine chemotherapy was still substantial, I believe I would benefit from a second round of Rituxan treatments if they are offered to me. The possibility of adapting the protocol accordingly for my cohort is being considered (the simultaneous chemo/Rituxan cohort is allowed two rounds of Rituxan, but my delayed Rituxan cohort is currently allowed only one).
In the meantime, I'm interested in seeing how my body will respond to the remaining hairies and feel that doing some more FACS tests to see if the burden increases or becomes undetectable again will help to substantiate or disprove theory #1. Over the next few months, we'll run some more FACS tests and see what happens. Let's hope my immune system kicks it.
Here's a slide show of my latest blood count results:
Since my last post in May, I've really been enjoying life. Taking lots of time to be with the family, a trip up to Hershey Park, and enjoying the weekends when the heat or rain doesn't make that impossible. It's been an incredibly happy time and given that the blood counts are continuing to improve, I really don't care about the few cells that were found in the peripheral bloodstream.
I should have another FACS in 4 to 6 weeks. I'll let you know how it goes.
