10/17/07 Time to Begin Treatment

Well, the good news is that they did not put me in the hospital today, the bad news is that it is time to begin treatment.

Today we went and saw my Hematologist / Oncologist to find out why I am feeling so tired. It was no surprise that he told me that my white blood count (WBC) has now gone up to 540,000 (keep in mind, normal is 5-10,000). It is doubling every six months, which is an indicator for treatment. With this high of a white count, the red cells are just being crowded out, which accounts for the anemia. There is more lymph node enlargements present, and I have experienced a 20 lb weight loss over 2 1/2 years (wouldn't recommend it as a way to lose weight). Along with being so tired, I can't walk up a flight of stairs without resting after I get there.

He had a recommendation for treatment, which is the most common protocol used when treatment is required. It is a chemotherapy cocktail of three drugs, Fludura, Cyclophosphamide, and Rituxan, or FCR. It is given IV over a multi week day cycle. This is a highly toxic regimen and leaves you open for other types of infections, and must be monitored closely.

I then told him we had a 2 week trip to France planned in November and I guessed I couldn't go on that. He then thought for a minute and said, why don't we go to option B, which would be Rituxan alone, which can be given over the next 4 weeks. You can read the description of Rituxan below. Rituxan is not chemotherapy, but is immunotherapy, so it doesn't have the same side effects as the FCR combination. What he said this would do, is GREATLY lower my white count. It would also dramatically shrink my lymph nodes (because that the hangout for all those white cells looking for a place to live.) He also said that after the couple of doses of the Rituxan if I was still tired they would just give me a couple of pints of Packed Red Blood cells to give me all my energy back. This would give me 2 - 4 - 6 months of remission, but it would not give me the long lasting results as the FCR combination would give me. When my counts go back up they would then begin the FCR protocol. He did not think that using the Rituxan approach would in any way affect my long term prognosis.

I asked him about going down to see Dr Kipps at UCSD for a second opinion and he was fine with that, and thought with all of my tests and lab results that Dr. Kipps would agree with the FCR protocol for ultimate treatment.

They will get all the insurance clearances tomorrow and set up the procedure for Friday or early next week.

Well, that's all for now, thanks to everyone for being concerned and keeping me in their thoughts and prayers.

Love
Terry

RITUXAN
Rituxan is an immunotherapy that has been administrated to thousands of patients worldwide. Immunotherapy uses your body's immune system to help fight cancer. This type of therapy targets certain types of cells and helps the immune system destroy them. Rituxan specifically targets CD20-positive B-cells-the cells involved in some types of NHL.
Healthy B-cells help your body fight infection. But in NHL, B-cells become cancerous and form tumors. Rituxan targets B-cells in tumors. It also targets healthy B-cells. But it leaves most other types of cells alone. Rituxan may be used on its own or in combination with chemotherapy. Side effects such as fever, chills, and shaking may occur with immunotherapy. If it is used along with another treatment, you may experience side effects from both.

Rituxan attaches to a certain marker, called CD20, on the surface of most B-cells.