Wednesday, July 3, 2013

Hairy Cell Leukemia: A Pleasant Surprise...

It's been a week since my restaging appointment at NIH.  Those of you in the trial know the routine:  CBC bloodraw in Phlebotomy, MRI and ultrasound in Imaging, then bone marrow biopsy and aspiration (my tenth) in Out-patient Procedures.  Get an X-ray and EKG in between those appointments. 

Waiting for results over the past week was nerve-wracking.  I got the CBC results that day.  My platelets were down slightly.  All white counts were normal, but looked like they were trending down too.  Red counts were fine, and they had certainly been pulling their share during all the recent hikes I've taken. 

Recovering from a head cold, I thought maybe that could account for the slight dip I perceived in the platelets and neutrophils.  Last year, 18 months after my final Rituxan treatment, my bone marrow aspirate came back slightly positive (.08%) for HCL.  At the time, Dr. K indicated that it might come back negative in a year, but I didn't think it would.  I assumed the cells would double every 3 weeks, and I'd have 60 to 80 weeks before I would need to be retreated.  Enough time to maybe let me get into an inhibitor trial and avoid chemo, which suppressed my marrow much longer than expected when I was first treated.  Thinking about going back for retreatment and the possibility of another chemo was starting to wear on me. 

Well, I'm pleased to report that both my peripheral blood and bone marrow aspirate flow results were negative for hairy cell leukemia - providing further data to show that using Rituxan to treat minimal residual disease (MRD) may allow the body to get an upper hand in keeping the disease in check.  In my case, chemo didn't get me into a partial or complete remission (CR), and a first cycle of Rituxan at 6 months post chemo to treat continued HCL infiltration allowed me to get a short-term CR.  A year later, when MRD first appeared, the second cycle of Rituxan had the opportunity to knock out what remained.

I've been in CR ever since that final treatment, and now there's no evidence of HCL at all!  My body is keeping it in check and appears to have eliminated the small amount that was detected last year.  Although the PCR lab was never able to clone my hairy cells to perform the hyper-sensitive MRD test and determine if HCL is completely eradicated from my body, I'm elated that I appear to have the upper-hand at this point.  The only supplement I take is 1000 IU of Vitamin D in the winter.  My diet is relaxed and normal, just no junk food or soda.  My ultrasound tech said my liver was now "textbook" and no longer fatty like it was when I was first diagnosed.

I couldn't have gotten to this point had I not participated in the NIH trial for newly diagnosed HCL patients.  I'm eternally grateful to Dr. K, Rita and the fantastic team at NIH.

Wednesday, June 5, 2013

Hairy Cell Leukemia: Making an Impact...

About 2.5 years ago, I blogged regarding a new drug I read about and brought to the attention of the Hairy Cell Consortium.  It's a Bruton's Tyrosine Kinase (BTK) inhibitor known as PCI-32765, and was inspired by a rare disease known as XLA, in which the body doesn't produce B-cells due to a BTK gene defect.  Developed to treat NHL, when I read about it, I thought the underlying mechanism warranted investigation for treating HCL.

Here's a link to the post:

http://jonshclblog.blogspot.com/2010/11/i-want-new-drug.html

Well, the email describing the mechanisms and potential of the drug that I sent to the Hairy Cell Consortium had an impact.  They performed in vitro studies of the drug, and it was found to be highly effective in stopping HCL proliferation!
Clinical trials using this drug to treat relapsed and refractory Hairy Cell Leukemia patients are now underway at The Ohio State University Medical Center (Go Buckeyes!!!) and The Karmanos Cancer Institute in Detroit Michigan!

http://www.clinicaltrials.gov/ct2/show/NCT01841723?term=Hairy+Cell+Leukemia&rank=4

The drug goes by the trade name Ibrutinib.  Let's hope it lives up to the potential I anticipated in my post back in 2010!  Seems like our arsenal and options are really piling up.  Translational medicine and targeted therapies are taking off, and will hopefully make chemo a distant memory someday soon. 

On a personal note:    Back in April, I went on a 5 day trek to the Royal Arch Loop of the Grand Canyon South Rim with some friends from work.  It was awesome!  The second to last day we hiked 13 hours in 80 degree weather and ran out of water, so we banded a team of 5 together for a 3-hour night hike down to the Colorado River to collect 40 liters of water for the rest of the team (9 of us altogether), so we could hike out the next day.  Awesome!  5 years ago, I couldn't climb 13 steps without stopping to catch my breath.  The last day of the Royal Arch trek, I hiked 4000 feet vertically with 32 pounds on my back for over 7 miles and felt fantastic!!!

I go for my annual re-staging at NCI/NIH on June 26th.  Wish me luck...

Elves' Chasm

Rappelling down a canyon wall

The Ravine to Royal Arch Creek

The Royal Arch!

Desert Blossom

Toltec Beach on The Colorado River

Night Hike and Water Filtering Mission

Sunday, January 20, 2013

It's Been Awhile...

It's hard to believe my last post dates back to July, 2011.  So much has happened since then.  Shortly after my last post, I experienced a significant drop in a type of white blood cell known as neutrophils, which I attribute to an effect known as Rituxan-related late-onset-neutropenia (LON).  I quickly recovered with the help of the expert staff at NIH, where I am being treated.  The neutrophil count of 700 that I alluded to in my last post was just the beginning.  I dipped all the way down to 0 but recovered quickly with the help of neupogen (aka: Neulasta), a hormone that induces the marrow to produce neutrophils.  Everything worked out fine in just a few days.  I'm grateful for everyone at NIH who treated me and helped me recover.  They are fantastic!

Otherwise, I've been working hard and just enjoying life.  Great progress has been made with respect to early treatments using Vemurafenib  (aka PLX-4032), the BRAF V-600E inhibitor that targets the mutation specific to nearly 100% of hairy cell classic cases.  UVA rays from sunlight induce the mutation (the same one that causes 50% of melanoma cases).  In other words, the cause of hairy cell leukemia is sun exposure.  A refractory patient in Germany was the first I know of to receive Vemurafenib, and now a patient in England -- an incredibly courageous individual who has seen more hardship over the past two years than I can imagine.  He's a pathfinder and an inspiration to many of us.  Both patients had given up hope of achieving a meaningful remission with the known chemotherapies (Cladribine, Pentostatin, and Bendamustine) and tried the Vemurafenib as a last hope.  I believe one of them got down to a platelet count of 10 (out of 160,000) when he started treatment.  This new drug appears to be working well -- melting away the refractory hairy cells, and also is being investigated to treat papillary thyroid cancer, which is also associated with the BRAF V600 mutations (thus probably caused by excess UVA exposure). 

NIH is preparing to start a trial in March, 2013 for refractory and relapsed patients that will investigate two other BRAF V600 inhibitors to treat HCL.  I will post a link to that trial and protocol when it becomes available.  Interested individuals should contact Dr. Kreitman at NIH. He always welcomes direct calls from patients (see his number in the blog sidebar). 

Personally, everything is well with me.  My counts are still great, and I had a peripheral blood flow cytometry test last week which was negative for hairy cells.  My last bone marrow biopsy was in June, 2012.  The core was negative for hairy cells, and the aspirate only showed 0.08% hairies, if I recall correctly.  I've started rowing 2 to 4 miles every day and hope to join a local rowing club soon.  The only daily supplement I take is 1000 IU of Vitamin D in the winter and early Spring.

I continue to highly endorse NIH for both new and refractory/relapsed patients.  The Cladribine + Rituxan trial has had a 100% remission rate for new patients (over 70 now), which is amazing.  I know I'd be in a very different position right now had I not received both rounds of Rituxan when I did -- to treat minimal residual disease instead of relapse.  My participation in the trial made all the difference in the world between achieving a CR (complete remission) and being among the 20% of patients who do not with just standard chemotherapy. 

All first time HCL patients should call Dr. Kreitman at NIH to discuss treatment options and submit research samples before proceeding with treatment, regardless of whether they decide to seek treatment at their local hemoncologist or NIH.

Just one more thing:  Here is a link to 15-year-old Jack Andraka's TED talk.  At 3-cents, his carbon nanotube antibody-based sensor (patent pending) costs 1/26000th that of the $800, 60-year-old ELISA test for pancreatic cancer and is 100 times more sensitive.  The possible applications cover a broad spectrum -- from water contamination to HIV detection, and will improve the lives of billions.  He's showing us that innovation can bridge the gap between providing services and cutting costs.  Glad Intel and the school systems are still supporting and promoting science fairs.  This is one helluva return on investment!!!


Happy New Year to All!

- Jon

Here are some articles related to the BRAF V600E mutation and HCL Classic:

The BRAF V600E Mutation in Hairy Cell Leukemia

BRAF Inhibition in Refractory Hairy-Cell Leukemia