After my last treatment in November, we had to wait two months before they could do a bone marrow biopsy to evaluate the marrow. On January 13th I had my 4th bone marrow biopsy with no major complications. The reason for this is to determine how much involvement of the leukemic cells are in the bone marrow and to determine the 'condition' of the marrow. This is the real test to measure how well the treatments worked. Before I had any real treatment in August 2009, my involvement was 80%, which as you can imagine, is not very good. After treatment this time I am at 30%. So, as we expected, the CLL cells still exist in the marrow.
What we do now is based on many factors, not just the results of a bone marrow biopsy. As a result of the bone marrow testing, Dr. Kipps feels like we got further than we did last year with this treatment, but we still did not get a Complete Response (CR). Dr. Kipps performed a physical exam and with the exception of one pesky node above my clavicle (which has always been there) all my nodes have remained the same size since my last visit (small or non-existent). My spleen is still small and my overall blood counts remain stable. The most important ones are the White (WBC), which is now at 13.4, my Hemoglobin, which is at 15.5, and my platelets, which are at 211. All of those counts are within NORMAL ranges. Based on the fact that it has only been about 2 ½ months since the end of my last treatment, and there are no signs of my disease progressing at a rapid rate, he once again wants to wait two months and see where we are. He said I still may be getting some residual benefits from the last rounds of treatment and there is no hurry right now to do anything. Sounds like the Army, Hurry up and Wait! He indicated he does want to start treatment while I am still stable, but that wouldn't probably start until April or May. We did discuss four different options for treatment. One is a tried and true treatment called Campath, which works well to clean out the marrow, but doesn't work so well if you have bulky lymph nodes (remember the pesky clavicle node). So unless that node goes down, this one may be out. Campath is also extremely immunosuppressive, which means your immune system gets hit very hard you have to be concerned about infections. He then gave me literature about two clinical trials that they are currently running at UCSD. One is the same one that I was looking at last year and the other adds two more drugs (A Combo) to that one. He also talked to me about a new clinical trial that they are trying to get approved to begin sometime in the spring. Based on my EXTREMELY quick review of the options I am already leaning towards the Combo treatment plan.
So I will continue my monthly IVIG infusions and then wait until March to figure out the exact plan.
I can honestly say that I am feeling no ill effects from either the CLL or from the last round of treatment. I continue to do the things I want (and need) to do. I play golf regularly (am now walking 18 holes), am in the process of finishing a sprucing up of our family room (painting & molding) and redoing a bath.
Your continuing prayers and thoughts are working wonders for my health and my spirit. Thanks
Terry
