Monthly Archives: November 2013

Flow Cytometry

I got an invoice a few days ago for the latest series of flow cytometry tests. Unfortunately, these blood tests tend to be really expensive. This is a modern diagnostic method which counts individual cell types for genetic testing to classify a case of CLL and identify its potential prognostic factors via Fluorescence Activated Cell Sorting (FACS). Here’s a good introductory video that explains the process.

This article also has some good basic info if you are interested. LINK

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Test Shown to Reduce Early CLL Deaths

Very very interesting. I’ve not heard of this one before. There are many CLL focused drugs out there and historically, many patients have not responded to them; particularly after a relapse. Prior to the new B cell receptor pathway inhibitors, mutations like my 17p deletion has been especially hard to manage. It seems like advances are coming every few days; the future is bright. Here’s a snippet:

Drs. Weisenthal and Bosanquet state that the SignatuRx(TM) personalized chemotherapy test can be ordered by physicians for their chronic lymphocytic leukemia patients from virtually anywhere in the world. Blood samples are sent to Dr. Weisenthal and Bosanquet’s California-based laboratory by overnight courier where the cancer cells are tested for susceptibility to treatment with up to 30 different chemotherapy drugs and drug combinations. Test reports are available in 7 to 10 days

The full article is here: Test Shown to Reduce Early CLL Deaths

CLL Vocabulary Lesson

There are many words I use in posts here that I never used prior to CLL entering my life. May this glossary help understanding some of the alphabet soup of clinical terms that frequently appear here.

Anemia [n]: A pathological deficiency in the oxygen-carrying component of the blood, measured in unit volume concentrations of hemoglobin, red blood cell volume, or red blood cell number.
Antibody [n]: Any of various proteins produced in the blood in response to the presence of an antigen. By becoming attached to antigens on infectious organisms antibodies can render them harmless or cause them to be destroyed See also immunoglobulin
Bone Marrow Biopsy (BMB) [n]: The removal of a sample of bone marrow and a small amount of bone through a large needle. Two samples are taken. The first is bone marrow by aspiration (suction with a syringe). The second is a core biopsy to obtain bone marrow along with bone fibers. After the needle is removed, this solid sample is pushed out of the needle with a wire. Both samples are examined under a microscope to examine the cells and the architecture of the bone marrow.
Chemistry Screen [n]: A chemistry screen is a blood test that measures the levels of several substances in the blood.

  • Albumin.
  • Alkaline Phosphatase.
  • Alanine Aminotransferase (ALT).
  • Aspartate Aminotransferase (AST).
  • Bilirubin (total and direct).
  • Blood Glucose.
  • Blood Urea Nitrogen.
  • Calcium (Ca) in Blood.
  • Carbon Dioxide (Bicarbonate).
  • Chloride (Cl).
  • Cholesterol and Triglycerides Tests.
  • Creatinine and Creatinine Clearance.
  • Gamma-Glutamyl Transferase (GGT).
  • Lactate Dehydrogenase.
  • Phosphate in Blood.
  • Potassium (K) in Blood.
  • Sodium (Na) in Blood.
  • Total Serum Protein.
  • Uric Acid in Blood.

CBC (Complete Blood Count) [n]: A diagnostic test which measures:

  • The number of red blood cells (RBC count)
  • The number of white blood cells (WBC count)
  • The total amount of hemoglobin in the blood
  • The fraction of the blood composed of red blood cells (hematocrit)

CT Scan [n]: A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body.
Immunoglobulin [n]: Any of a group of large glycoproteins that are secreted by plasma cells and that function as antibodies in the immune response by binding with specific antigens. There are five classes of immunoglobulins: IgA, IgD, IgE, IgG, and IgM.
Lymphadenopathy [n]: Chronically swollen lymph nodes.
Lymphocyte [n]: Any of the nearly colorless cells found in the blood, lymph, and lymphoid tissues, constituting approximately 25 percent of white blood cells and including B cells, which function in humoral immunity, and T cells, which function in cellular immunity.
Lymphocytosis [n]: An abnormal increase in the number of lymphocytes in the blood.
Monoclonal Antibody [n]: Any of a class of antibodies produced in the laboratory by a single clone of cells or a cell line and consisting of identical antibody molecules
Neutropenia [n]: An abnormal decrease in the number of neutrophils in the blood.
Splenomegaly [n]: Enlargement of the spleen.
Thrombocyte (also known as platelet) [n]: A minute cell occurring in the blood of vertebrates and involved in clotting of the blood
Thrombocytopenia [n]: An abnormal decrease in the number of blood platelets.

Please let me know if I’ve missed anything.

Gazyva (obinutuzumab)

fda-logo-vector

The FDA has approved another new drug (monoclonal antibody) to treat CLL. Known as GA-101 during its clinical trials, Gazyva in concert with another drug Chlorambucil has shown improved outcomes in progression free survival (PFS), a key treatment metric. It’s also the first CLL drug approved under the new breakthrough therapy designation. You can check out the agency’s release here.

Gazyva works by helping certain cells in the immune system attack cancer cells. Gazyva is intended to be used with chlorambucil, another drug used to treat patients with CLL.

Gazyva is the first drug with breakthrough therapy designation to receive FDA approval. This designation was requested by the sponsor and granted soon after the biologic license application to support marketing approval was submitted to the FDA. The FDA can designate a drug a breakthrough therapy at the request of the sponsor if preliminary clinical evidence indicates the drug may offer a substantial improvement over available therapies for patients with serious or life-threatening diseases.

The FDA also granted Gazyva priority review because the drug demonstrated the potential to be a significant improvement in safety or effectiveness in the treatment of a serious condition. And the FDA granted Gazyva orphan product designation because it is intended to treat a rare disease.

The FDA also granted Gazyva priority review because the drug demonstrated the potential to be a significant improvement in safety or effectiveness in the treatment of a serious condition. And the FDA granted Gazyva orphan product designation because it is intended to treat a rare disease.
“Today’s approval represents an important new addition to the treatments for patients with CLL,” said Richard Pazdur, M.D., director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research. “This approval reflects the promise of the Breakthrough Therapy Designation program, allowing us to work collaboratively with companies to expedite the development, review and availability of important new drugs.”
Gazyva’s approval for CLL is based on a study of 356 participants in a randomized open-label multicenter trial comparing Gazyva in combination with chlorambucil to chlorambucil alone in participants with previously untreated CLL. Participants receiving Gazyva in combination with chlorambucil demonstrated a significant improvement in progression free survival: an average of 23 months compared with 11.1 months with chlorambucil alone.

17p Deletion in CLL

karyotypeRe-Blogging something I found yesterday which helps explain small arm 17p deletion; the chromosomal mutation I have which makes my CLL more sinister. Dr Sharman helps explain it well and explains why traditional chemotherapy regimens like FCR (Fludarabine,Cyclophosphamide & Rituxan) for CLL generally don’t work well for patients w/ 17p deletion.. Thanksfully, Ibrutinib is well on its way to approval by the FDA and the trial drug I am taking (ipi-145) also seems to be working for me. Here’s a snippet of his post. You can read his full post via Dr. Sharman’s CLL & Lymphoma Blog

When we say 17p deletion CLL, what we mean is that the short (petit) arm of chromosome 17 is missing.  You have 23 pairs of chromosomes (46 total) and as you get higher in the numbering, the chromosomes get smaller and smaller.  It is probably an excessive simplification to say that the biology of 17p is all about one particular protein called p53 – but for the time being that is most of the story.

P53 is affectionately called “the guardian of the genome.”  Every time I read about p53 I discover some new function of the protein that I didn’t know about before.  It has a tremendous number of different functions.  One of the most important though is that it will bind to DNA in a bunch of places and turn on / off the genes at those locations.  In this role it is known as a “transcription factor.”  Many of the proteins that are regulated by p53 have to do with cell survival or cell death.  When P53 decides it is time for a cell to die – very few things can stop that.  The most important signal that turns on p53 is DNA damage (hence – guardian of the genome).

How do you keep your sanity?

Some might argue my sanity has been missing for quite a while. Waiting for reports and labs when you’re fighting cancer can be really stressful and tiring. I’m curious how others fighting the evil C word manage to keep their sanity. My latest method is home recording, mixing pre-recorded guitar & drum tracks w/ my own vocals and bass guitar ones. It’s experimental so far but has proven to be a lot of fun and very effective at melting away unwanted stress. No, I’m not a good singer and not an especially good bass player but hey, who cares?

R O C K in in the U S A. 😉

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