Saturday, March 30, 2013

Keeping your medical file organized


By Andrew Griffith

Andrew Griffith has mantle cell lymphoma and has had an auto (November 2009) and an allo (August 2011) stem cell transplant. He lives in Canada and is married with two young adult children. He blogs atwww.lymphomajourney.wordpress.com and can be followed on Twitter @lymphomajourney.

Most of us find it challenging to make sense of the wave of information when we enter our cancer journey. This is foreign territory, with its own language, culture and routines. It takes time to absorb and understand.

We're not oncologists or hematologists. However, we can learn to improve our discussion with our medical team.

Tips to help
Build your knowledge: By the time you start your treatment, you'll likely have searched the web and read brochures on your cancer. Ask your medical team which sites have reliable and up-to-date information to avoid old and possibly discouraging information on treatment outcomes.

While blogs and support forums help give a real-world view of the range of experiences, you're an individual, and too much thinking about what happens to others, good or bad, increases worry further. Moderation!

To save time, set up Google Reader for news sites, blogs and forums, and use the search function (general terms like cancer or lymphoma) to narrow down articles of interest.
Keep a notepad: At each appointment, take notes. Chemo brain or not, this is new territory and hard to master. Come with someone, either as a listener or a scribe. My wife played the first role and it helped ensure that we both heard and understood the consequences the same way.

Start a binder: As you go through treatment, you'll get more and more paper. I started a binder, organized with these categories: contact info (first page), treatment plan, test results, background information and drug information. The purpose is to have all reference material in one place, to consult and take to hospital and clinic visits.

Be prepared:
 Prepare a list of questions for the medical team for your clinic check-ups (I found it harder during the daily hospital routine). My doctors are busy people.

However, they always take time to answer my questions. If I weren't prepared, the appointment would be limited to a brief summary of my condition.

As treatment varies depending on the doctor, having detailed notes and questions helps track any changes. Given my group practice, I questioned my team about changes (scan or not to scan, when to stop immunosuppressants) -- not to challenge their judgment but to ensure I understood their rationale for the change.

While every patient gets good care, an empowered patient becomes a partner in treatment, one that my medical team appreciated, and may have resulted in better care.

Go electronic: I started with a paper system. My second time around, I switched to an iPad and downloaded apps that helped to: 
  • Organize clinic notes and questions
  • Track my blood counts, blood pressure and weight
This was very effective in keeping me on top of my medical file with my medical team -- they become used to me being very prepared.

While all of us have different ways, being organized is one of the few areas in which you can have some control in a situation that's beyond your control, and strengthen the partnership with your medical team. It may not change the outcome, but it may increase your confidence in treatment pursued.

Read more posts by Andrew Griffith.

Listen...

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When I ask you to listen to me and you start giving me advice, you have not done what I asked.

When I ask you to listen to me and you begin to tell me why I shouldn't feel that way, you are trampling on my feelings.

When I ask you to listen to me and you feel you have to do something to solve my problem, you have failed me, strange as that may seem.

Listen! All that I asked was that you listen - not talk, or do - just hear me.

Advice is cheap. Thirty five cents will get you both Dear Abby and Billy Graham in the same newspaper.

All I can do is do for myself. I am not helpless - maybe discouraged, but not helpless.

When you do something for me that I can and need to do for myself, you contribute to my fear and inadequacy.

But, when you accept as a simple fact that I do feel what I feel, no matter how irrational, then I can quit trying to convince you, and get about thisbusiness of understanding what is behind this irrational feeling.

When that is clear, the answers are obvious, and I don't need advice. Irrational feelings make sense when we understand what's behind them.

So, please listen and just hear me. If you want to talk, wait a minute for your turn - and I'll listen to you.

From NHL discussion group


Friday, March 29, 2013

FAQs about living a long life...

What appears below is a post from an NHL disussion group. Thanks to Greg Dafoe, Hamilton, Ontario

Greg: I am popping a chocolate Easter egg in my mouth as I type this (truly I am actually doing that).

Q: I've heard that cardiovascular exercise can prolong life. Is this true?
A: Your heart is only good for so many beats, and that's it...don't waste them on exercise. Everything wears out eventually. Speeding up your heart will not make you live longer; that's like saying you can extend the life of your car by driving it faster. Want to live longer? Take a nap.

Q : Should I cut down on meat and eat more fruits and vegetables?
A: You must grasp logistical efficiencies. What does a cow eat? Hay and corn. And what are these? Vegetables. So a steak is nothing more than an efficient mechanism of delivering vegetables to your system. Need grain? Eat chicken. Beef is also a good source of field grass (green leafy vegetable). And a pork chop can give you 100% of your recommended daily allowance of vegetable products.

Q: Should I reduce my alcohol intake?
A: No, not at all. Wine is made from fruit. Brandy is distilled wine, that means they take the water out of the fruity bit so you get even more of the goodness that way. Beer is also made out of grain. Bottoms up!
>
Q: How can I calculate my body/fat ratio?
A: Well, if you have a body and you have body fat, your ratio is one to
one. If you have two bodies, your ratio is two to one, etc.

Q: What are some of the advantages of participating in a regular exercise program?
A: Can't think of a single one, sorry. My philosophy is: No Pain...Good

Q: Aren't fried foods bad for you?
A: YOU'RE NOT LISTENING!!!. Foods are fried these days in vegetable oil. In fact, they're permeated in it. How could getting more vegetables be bad for you?

Q: Will sit-ups help prevent me from getting a little soft around the middle?
A: Definitely not! When you exercise a muscle, it gets bigger. You
should only be doing sit-ups if you want a bigger stomach.

Q: Is chocolate bad for me?
A: Are you crazy? HELLO ...... Cocoa beans ... another vegetable!!! It's the best feel-good food around!

Q: Is swimming good for your figure?
A: If swimming is good for your figure, explain whales to me.

Q: Is getting in shape important for my lifestyle?
A: Hey! 'Round' is a shape!

Well, I hope this has cleared up any misconceptions you may have had about food and diets and remember, "Life should NOT be a journey to the grave with the intention of arriving safely in an attractive and wellpreserved body, but rather to skid in sideways - Chardonnay in one hand - strawberries in the other - body thoroughly used up, totally worn out, and screaming - 'WOO HOO! What a Ride!'"

Humor is mankind's great blessing ~ Mark Twain



Be The Melody...

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Wednesday, March 27, 2013

Testimonial from a Mantle Cell Lymphoma Survivor

These encouraging words are from The Voice: A Christian cancer blog. From our experience, I agree with everything stated by the blogger, especially this statement "My personal opinion is mantle cell needs a specialist’s diagnose and treatment. They are up to date with the ongoing MCL research and generally will prescribe a protocol modeled after one of the top research hospitals." Things are happening quickly in MCL research, and it will definitely be to your disadvantage if your oncologist has not seen a patient with MCL for awhile, and/or they haven't been keeping up with what's going on with MCL research at the top research hospitals, such as, Vanderbilt and MD Anderson. Do as much research as you can, and don't be afraid to question your oncologist. Your life could depend on it. Gerry

If you searched on Google for information regarding cancer, specifically mantle cell lymphoma, please read this article.

In April 2008, I was diagnosed with mantle cell lymphoma. This was a complete surprise as I was a conscientious woman concerning my health and I exercised regularly. I never thought I would be a candidate for cancer! (read my complete story – here)

I went to the internet to learn more about this cancer but what I read concerning mantle cell lymphoma was bleak. The reports were dismal as far as the odds of beating this disease. I want you to know that if you went to the internet to learn more about MCL, don’t be discouraged or frightened, the news is actually more hopeful than those articles.

I started chemotherapy May 5, 2008. I felt like I was on the fast track and all I could say to my oncologist was “Yes” to anything and everything she suggested. What did I know about this cancer called lymphoma? So my chemotherapy journey began in May and ended in September. After a six week “rest” of numerous appointments and tests, in November I was admitted into the hospital for my autologous stem cell transplant. At my 100 day post transplant, February 2009, my bone marrow transplant doctor told me the good news that I was cancer free. And he felt confident enough to say “forever.”

I chose to go to a research hospital for my treatment. I went to Huntsman Cancer Hospital in Salt Lake City, Utah. My oncologist, Dr. Martha Glenn, was a specialist in blood cancers, hematology. My personal opinion is mantle cell needs a specialist’s diagnose and treatment. They are up to date with the ongoing MCL research and generally will prescribe a protocol modeled after one of the top research hospitals.

My treatment was researched and developed by MD Anderson, Texas. I had six cycles of AB rituximab hyper-CVAD, a very aggressive chemotherapy regime. I did well, as expected. I don’t know if any chemotherapy goes as planned, I think most every patient has glitches along the way, some minor and some not so minor. As each cycle went by, I felt weaker and weaker. I actually got a little frustrated with my lack of energy and ability to accomplish anything.

In preparation for my transplant, a PET/CT scan revealed I was not 100% responsive to my chemotherapy. After a board of oncologists discussed my case, it was decided that BEXXAR, a radioimmunotherapy, would be prescribed followed by 17 rounds of radiation once I was released to go home after my transplant.

This month, March 2013, I had my nearly five year since diagnose appointment with my oncologist. At this point, my only test is a full blood panel. Dr. Glenn said as each year goes by post treatment, the less chance I have of my cancer returning. As a matter of fact, during my first year appointments she would tell me in her five years of using my type of treatment protocol, it has not failed but for one patient. As time has passed, she told me again at this appointment, now in ten years of prescribing R hyper-CVAD her record stands, only one patient relapsed.

Dr. Glenn was so pleased with me and my test results that she believes I am cured. That word “cured” is not used very often in the MCL world and is debated among the oncologists but with Dr. Glenn’s optimism, I will believe I am cured.

Mantle cell lymphoma is not a cancer to fool around with. In my years as a survivor I have kept up to date with the research and data surrounding MCL. We have some highly intelligent MCL doctors that are unrelenting in their research looking for the cure to our cancer. In the five years since my diagnose, research has discovered new drugs that are less toxic and easier on the body. Many of these drugs are in clinical trial. The doctors seem to think in the near future years MCL can be cured. In my reading, MCL is a maintainable disease and some oncologists have even called it a chronic disease.

In being cautious, all of us will not have my type of treatment. The oncologist must consider age and health factor at diagnose. With this in consideration, they will prescribe the chemotherapy treatment most effective and least life threatening to the patient. I met a man who was about my age diagnosed with MCL. He was a smoker and his tests revealed he couldn’t handle my specific treatment, it had to be modified for his situation.

Also in my reading, not all doctors prescribe the same treatment regime; there are chemotherapy options available and one doctor may favor one over another. To me this is very interesting.

[...]

So for your research in finding any positive information regarding mantle cell lymphoma I hope this article has helped you in some way.

Again, we may be prescribed different treatment regimes and we may respond just as differently to our personalized chemotherapy but there is a point to be made – MCL is not a hopeless cancer. As my doctor said to me, “You had the kitchen sink thrown at you and because of that, you are cured.”

With a little research on the internet you can find the names of the nationally and world renowned doctors treating mantle cell lymphoma. Many of these doctors are associated with research hospitals and are working on finding the cure for our cancer.

Read the entire article here...



Forgive Yourself

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Monday, March 25, 2013

God grant me the serenity...

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Please pray for, my sister in law, Carol

Carol is Mary Jo's older sister. She had major surgery a few weeks ago for a sliding hiatal hernia, ulcers and other problems. She had been out of rehab about a week, or so, and seemed to be going downhill, instead of improving.

Carol was taken to the hospital on Monday afternoon. The doctors there said that she has had a heart attack sometime in the last few days, and Monday evening we found out that she also has pneumonia.

Carol will be undergoing tests today. Please keep Carol in your prayers in the coming days.




Current and Emerging Therapies in Mantle Cell Lymphoma

This opinion statement doesn't reveal anything new. But it gives a good but brief overview of some of the current strategies and novel treatments for mantle cell lymphoma. At the very least it gives all the MCL people, a list of options to discuss with their doctors.

OPINION STATEMENT:

March 20, 2013

Mantle Cell Lymphoma, characterized by the t(11;14)(q13; q32) chromosomal translocation and cyclin D1 expression, remains one of the most challenging lymphoma subtypes to treat. Therapy can be divided into treatment modalities for younger, stem cell transplant (SCT)-eligible patients vs older, SCT-ineligible patients.

For clinically fit patients younger than 60-65 years of age we recommend cytarabine-containing induction and conditioning regimens such as Rituximab (R)-CHOP alternating with R-DHAP followed by autologous SCT consolidation.

Elderly patients benefit from R-bendamustine or R-CHOP with maintenance rituximab following induction therapy, especially after R-CHOP. While standard chemoimmunotherapy provides high overall response rates, the responses are not durable and sequential therapies are thus necessary.

MCL is proving to be sensitive to novel therapies that may in the near future become useful adjuncts to standard regimens. For example, bortezomib, lenalidomide, and temsirolimus each have single-agent efficacy in relapsed and refractory disease.

Several targeted agents are emerging that likewise may transform management of MCL. The B-cell receptor pathway appears to be critical in the pathogenesis of MCL, and novel agents such as ibrutinib and idelalisib that target this signaling pathway are highly active in relapsed and refractory MCL.

Similarly, cell cycle inhibitors targeting cyclin dependent kinases as well as HDAC inhibitors have shown promise in early studies.

Hematology/Oncology Division, University of Virginia Health System, Hospital West, Room 6023, Jefferson Park Avenue, Charlottesville, VA, 22908, USA.

h/t Greg Dafoe, Hamilton, Ontario


Our Vanderbilt Odyssey Calendar

Merriam-Definition of ODYSSEY

1: a long wandering or voyage usually marked by many changes of fortune

2: an intellectual or spiritual wandering or quest

My brother, Steve, came up with a great name for this journey that we are on. He called it Our Vanderbilt Odyssey. I think either Webster's definitions would be appropriate for this journey that we have been on since we first found out that May Jo had Mantle Cell Lymphoma on October 16, 2009.

TRANSPLANT CALENDAR 

D-25  Pre-admit and Cold & Flu test
D-24  Line placement (fasting) 
D-23  Dressing change
D-22  Neupogen shot  
D-21  Neupogen shot
D-20  Neupogen shot 
D-19  AM Labs, Neupogen shot & possible stem cell collection
          PM Mozobil injection
D-18  AM Neupogen shot & stem cell  collection
           PM  Mozobil injection  
D-17  Possible stem cell collection
D-16 through D-8  Off
D-7  Pre-admit, visit, & PET scan
D-6  All day Cytoxan & Etoposide Chemo
D-5  All day Cytoxan & Etoposide Chemo
D-4  All day Cytoxan & Etoposide Chemo
D-3  All day Cytoxan & Etoposide Chemo 
D-2  All day BCNU Chemo  
D-1  AM Clinic Visit
D+0  REBIRTH DAY Noon Stem Cell Infusion 
D+1 through D+30 Recovery
D+100  Goal for total recovery

GIVE THANKS FOR ALL OF LIFE!

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Saturday, March 23, 2013

Mary Jo Update #1 - Pre-transplant tests completed

Mary Jo and I went to Vanderbilt yesterday for her electocardiogram, echocardiogram, blood tests (they took 19 vials of blood), and pulmonary function test. We also met with the a transplant nurse practitioner, transplant doctor and social worker. We now have a clearer picture of what will be involved with Mary Jo's stem cell transplant, and a schedule when the process will begin.

The good news is we will be here for Holy Week and Easter activities. The bad news is the process is a little longer than we thought.

When we go back to Vanderbilt Mary Jo will have another port installed for the transplant. Then, she will receive Neupogen shots to promote the blood cell production in her bone marrow. Her stem cells will then be collected until they have enough to do the transplant. They need 2 million.

We will be home a week, Then go back to Vanderbilt for the transplant. She will have several days of high dosage chemo. Then, her stem cells will be given back to her. This will be her re-birthday, commonly called D+0. We will go home on D+30.

Neither of us can take a chance on getting any kind of infection that could affect her transplant schedule. If either of us is sick when we go down there on the 28th, they will send us home and re-schedule the transplant which means we would have to lease an apartment again. So, it is incumbent on both of us to stay well.

Thanks in advance for you continued thoughts and prayers,

Gerry



A Sobering Look: Cancer in Canada

War On Cancer Read Article Here

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Tuesday, March 19, 2013

Mary Jo Update

When Mary Jo had her colonoscopy a couple of weeks ago, the gastro-intestinal doctor did a process called "tatooing" where tissue samples are taken in several areas. The doctor told us that he took samples from an inflamed area in her small intestine where he was concerned could have lymphoma cells present. The lymphoma cells actually mimic an inflammatory bowel disease.

Today, he called to confirm that the pathology tests did indicate low grade lymphoma cells were present. Although this was disturbing for us, Mary Jo's oncologist called the transplant doctor, and she indicated that this would not affect plans for the stem cell transplant. It is hard to believe that the lymphoma cells were able to survive the two high dose R-DHAP treatments. The doctor said that the stem cell transplant should take care of the low grade cells that were found.

We are scheduled for more tests at Vanderbilt this Friday. It will be a full day from 8:30 am to 4:30 pm. The tests include more coronary and pulmonary testing, along with some sort of blood test that they can detect every kind of virus that you have ever had in your life.

We will be going back for what is called mobilization and stem cell collection after that. The time on that varies from 4-7 days. They like to collect 4-5 milion stem cells. The mobilization part is the Neupogen shots that are given to promote bone marrow blood cell production.

After the stem cell collection we will go home for 7-10 days, then back for a high dose chemo treatment. Rest for 2-3 days. Then, the stem cell transplant. We will be there for another 10-14 days until the stem cells graft to her body.

Your continued thoughts and prayers are appreciated.



Monday, March 18, 2013

Today I choose to trust...

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h/t Linda Medley



Prayers needed: Steve and Peggy in NC

Steve and Peggy are cyber friends of ours whom we met through an online Non-Hodgkins Lymphoma support group. Steve was diagnosed with Mantle Cell Lymphoma recently. Steve and Peggy live in North Carolina. Steve was taken to the hospital the other day after he had a severe reaction after his second chemo treatment at Duke Cancer Center. A change in his chemo regimen may be necessary. It's amazing how different our bodies are. A chemo drug that works on some people has terrible results for others. Please keep Steve and Peggy and all patients and caregivers and falilies who are in the fight against the C word. Saint Peregrine, pray for us.



Thursday, March 14, 2013

Chemo Brain • Chemo Teeth




Lately, Mary Jo and I have been kidding each other when we encounter one of our frequent mental lapses. It is a known fact that one of the side effects of some chemo drugs are cognitive lapses in some patients called "chemo brain." So now rather than blaming our forgetfulness on our advancing years, we have a new scapegoat- chemo.

Even though, I, the caregiver, never had any chemo enter my body. I have taken the liberty of calling my senior moments "chemo brain", too by virtue of the close association that I have had with the chemo recipient.

Now, we have found something else that we can blame on chemo. We are calling it "chemo teeth".

When we went to Vanderbilt a couple of weeks ago, one of the instructions from the nurse practioner at the transplant center was for Mary Jo to make an appointment with her dentist.

Dentist-chemo! I never made the connection. I have read a lot about cancer in general, non-hodgkins lymphomas, chemo drugs, etc. before and since Mary Jo's lymphoma became aggressive. Somehow, I missed that one.

One website sponsored by Colgate says you should go to the dentist 2 weeks before you start chemo. We didn't have that much lead time. Mary Jo was admitted to the hospital on a Tuesday, and her first treatment began on Friday of that week back in October. The website says that even if you have started chemo treatments that you should go to the dentist, as soon as possible.

Luckily, Mary Jo had actually went to the dentist on  her own shortly before her first treatment. When she went to the dentist today, she found out that she had developed a couple of cavities because of the effect the chemo has on the salivary glands, and the balance between the beneficial bacteria and harmful bacteria in the mouth that allows the harmful bacteria to take over.

Mary Jo's dentist told her that she should have been given some sort of mouth wash during the treatments to counteract the effect of the chemo drugs. That didn't happen. It's easy to see how things could fall in the crack sometimes with the number of drugs, chemo and other drugs, antibiotics, steriods, etc. that are part of the chemo treatments. Although, it should never happen.

From our experience, it is definitely beneficial for the caregiver and patient, if possible, to read and learn, as much as possible, about the drugs, procedures, etc. that will be a part of the patient's treatment regimen.

Do not be afraid to question doctors or nurses about what they are doing, or not doing, if you do not understand something that is going on. Even the best doctor or nurse is capable of overlooking something, or making a mistake.

All of the doctors and nurses that cared for Mary Jo at Baptist Health were happy to take the time to answer any questions that we had. If you are a caregiver, it definitely helps if it is obvious to the doctor or nurse that you have done your homework.

Remember, one of the most important duties of your job as a caregiver is being your patient's advocate.

Preparing for Stem Cell and Bone Marrow Transplant FAQ

What should I bring to the hospital?
Loose-fitting, comfortable clothes (sweat pants, shorts, t-shirts)
Shoes for walking in the halls
A list of your current medicines
Pictures, posters and other small items to make your room cozy
CD player, iPod, or laptop computer, if you wish
Scent- and dye-free laundry detergent, if you want to do your laundry
Cell phone and charger
Leave all jewelry at home
What can I do to prepare for blood and bone marrow transplant?
Make sure your family knows where important financial and legal documents are kept. Write down a list of regular chores and household upkeep you do so that your family is prepared to take over those activities during your absence.
If you have children make sure there are plans for how they will be cared for while you are recovering and make plans for how and when they can visit you in the hospital. Keep them informed of plans and changes.
Provide a medical release granting a caregiver, family member or friend permission to authorize medical care for children in your absence.
Discuss with someone you trust the possibility of making them your Durable Health Care Power of Attorney.
Organize how your bills will be paid while you are away. Make sure your health insurance premiums are paid on time, even while you are hospitalized.
Leave a list of numbers that your family can call if they need help fixing things (plumbers, carpenters, etc.) so they do not have to rely on you while you are recovering.
Prepare your family and friends that your appearance and demeanor may change during and after treatment.
Family and friends will want to help. Let them know ahead of time what would be beneficial to you.
Why should I go to the dentist prior to blood/bone marrow transplant?

If you have not had a recent dental check-up, you should make an appointment with your local dentist. If you have low blood counts, make sure that your dentist knows. Ask your dentist to look for any possible sites of infection in your teeth and mouth. Unhealthy teeth and gum tissue can become a serious infection problem during transplant.

What impact does smoking have on stem cell transplants?

Many transplant complications are more severe in patients who smoke. This includes mouth sores and lung problems that can be life threatening. If you smoke, you must stop. Your transplant doctor and coordinator can help provide information and, in some cases, prescribe medicine to help.

Can blood and bone marrow transplants affect fertility?

Yes. Most, but not all, transplant conditioning regimens (chemotherapy and or total body irradiation) can cause the transplant patient to become infertile as a result of treatment. There may be options to consider if you wish to have children in the future. For men, sperm banking, a process which involves freezing and storing your sperm, is an option you might want to explore. For women, if there is enough time before treatment of your cancer is required, it may be possible to freeze either your eggs or embryos before you undergo your treatment. Make sure to tell your transplant coordinator or your doctor that you would like to explore these options as early as possible before transplant. He or she will be able to refer you to UW Health fertility specialists to further explain your options.

Is pregnancy an option during blood and bone marrow transplant?

No. You should not become pregnant or father a child at anytime during your treatment. The medicines used can be harmful to an unborn child. Talk to your doctor about birth control options.

How should I prepare my home for my return after my transplant?

It is important to have a clean home to return to after transplant because your body's ability to fight infection will be low for awhile after the transplant.
Carpets and rugs should be carefully vacuumed. Only carpets with heavy soiling need to be shampooed.
Change filters in air conditioners and furnaces. Buying an air filter unit is not required.
All toilets, showers, counters, sinks, and tubs should be cleaned.
Rooms need to be free of mold and mildew. Don't remodel your home at this time as this activity can cause mold spores to be released into the air.
Remove fresh or dried flowers from your home.
House plants are allowed, but should be limited to one room in the house.
Have all visitors wash their hands and avoid contact with persons who are sick.
Use alcohol-based hand gel or soap and water after each contact with pets or pet cages.
Avoid contact with animal waste.




Wednesday, March 13, 2013

Mary Jo accepted for auto stem cell transplant!!!

We received news late yesterday afternoon from Mary Jo's doctor at Vanderbilt Cancer Center. She has been accepted and is on the priority list for an autologous stem cell transplant there.

Mary Jo had her last meeting today with her oncolgist here in Louisville until after the the transplant. Tomorrow she has appointments with her dentist and primary doctor.

We received several calls today from people at the transplant center at Vanderbilt checking on routine tests, mammiogram, etc. that Mary Jo has had in the last two years. Also, her transplant nurse set up an appointment for us in Nashville next Friday, March 22 for a full day of additional tests there that are needed before the transplant.

The nurse also gave us a rough idea what our future travel plans will be. After next week, we will be going down there for a few days when they will harvest her stem cells for the transplant. She will receive several Neupogen shots to promote blood cell production in her bone marrow.

After the stem cells are harvested, they will be frozen and we will come home for 7-10 days. This will be a critical time because Mary Jo will have no immune system. Isolation from anyone or anything that could cause an infection will be necessary. After that, we will be going back to Vanderbilt for the transplant and recovery, normally 30 days.

We will find out a more specific timeframe for all of this soon. Not sure if we will be here for Easter, or not, at this point.

Thanks for all of your prayers and support.



Ibrutinib Has 'Unprecedented' Impact On Mantle Cell Lymphoma

Dec. 14, 2012 — An international study of ibrutinib in people with relapsed or refractory mantle cell lymphoma (MCL) continues to show unprecedented and durable results with few side effects.

Researchers from The University of Texas MD Anderson Cancer Center presented interim findings of the multi-center Phase 2 study December 16 at the 54th American Society of Hematology Annual Meeting and Exposition.

"I believe we are witnessing a breakthrough in mantle cell lymphoma. This is great news for patients," said Michael Wang, M.D., associate professor in MD Anderson's Departments of Lymphoma and Myeloma and Stem Cell Transplantation and Cellular Therapy. Wang is lead author of the study.

Wang, director of the mantle cell lymphoma (MCL) program at MD Anderson, has spent the past 12 years researching the disease, including clinical trials of proteasome inhibitors, immune-modulating agents and an mTOR inhibitor.

"In a heavily treated relapsed or refractory population, oral ibrutinib induced a response rate as high as 70 percent -- better than any other single agent ever tested in MCL," he said. "The response is durable with a long progression-free survival. "

Dangerous disease presents treatment challenges

MCL is a rare and aggressive B-cell subtype of non-Hodgkin lymphoma that, according to the Leukemia and Lymphoma Society, accounts for 6 percent of non-Hodgkin cases. Despite high response rates to initial combination-drug chemotherapy, which is highly toxic, patients often relapse.

Bruton's tyrosine kinase is a mediator of B cell receptor signaling, which is essential for normal B-cell development. Ibrutinib inhibits Bruton's tyrosine kinase (BTK), causing cell death and decreasing cellular migration and adhesion in malignant B-cells.

"The foundation for this clinical success is based on biology," Wang said. "The B-cell receptor pathway is critical in B-cell lymphoma. BTK is the driver molecule in this pathway, and ibrutinib targets the BTK molecule."

Oral medication

Preliminary results reported at ASH in 2011 included 51 patients and demonstrated ibrutinib can achieve rapid response, including complete response, in relapsed and resistant MCL.

To date, 115 people have enrolled in the study. Of these patients, 110 were evaluated for the drug's efficacy. Patients had a median age of 68 years, time since diagnosis of 42 months, three prior treatments and 77 percent had stage 4 disease.

Ibrutinib was given orally at 560 mg daily in continuous 28-day cycles until disease progression.

Strong results, low toxicity

With a median follow-up period of 9.2 months, overall response rate was 68 percent, and complete remission rate was 22 percent.

Responses increased with longer time on study treatment:

* Median time to partial response was two months

* Median time to complete remission was four months

* Median time on treatment was six months

* 53 percent of subjects remain on treatment

Response was even more dramatic in the 51 original patients with:

* Overall response rate of 75 percent

* Complete remissions in 39 percent

* Median time on study treatment 15 months

"What impressed me the most is the high complete remission rate, which continues to improve with time, and yet it is the safest drug we have for mantle cell lymphoma," Wang said. "Previously such a rate could be achieved only with combination cyto-reductive chemotherapy, which is bone marrow suppressive and toxic."

Most side effects were minor and included diarrhea, fatigue, upper respiratory tract infections, nausea and rash. Grade 3 or higher effects included low white cell blood counts, anemia and diarrhea. One case of pneumonia was thought to be treatment-related. This was consistent with safety data previously reported, Wang said.

A pivotal study in relapsed and refractory MCL patients following bortezomib treatment has begun.

Pharmacyclics, Inc., which developed ibrutinib, sponsored the clinical trial.

Clinical trial collaborators and co-authors are Jorge Romaguera, M.D., also of MD Anderson's Department of Lymphoma and Myeloma, Simon Rule, M.D., of Derriford Hospital, Plymouth, United Kingdom; Peter Martin, M.D., Weill-Cornell Medical College, New York; Andre Goy, M., John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, N.J.; Rebecca Auer, M.D., Barts Cancer Institute, Queen Mary University of London; Brad Kahl, M.D., University of Wisconsin School of Medicine, Madison, Wisc.; Wojciech Jurczak, M.D., Jagiellonian University, Krakow, Poland; Ranjana Advani M.D., Stanford University School of Medicine; Jesse McGreivy, M.D., Fong Clow, Sc.D., Michelle Stevens-Brogan, and Lori Kunkel, M.D. all of Pharmacyclics, and Kristie Blum, M.D. of The Ohio State University, Columbus, Ohio.

All academic institution co-authors receive research funding from Pharmacyclics. The company's co-authors all have an equity ownership in Pharmacyclics.




My Mantle Cell Lymphoma Journal

This blog is under construction. My wife, Mary Jo, was diagnosed with Mantle Cell Lymphoma(MCL)in October, 2009. It was indolent until the MCL developed a blastic variant and became agressive in October, 2012. Mary Jo recently completed 6 rounds of chemo, and is now preparing for a stem cell transplant at the Vanderbilt-Ingram Cancer Center in Nashvillle, Tennessee soon. Hopefully, this blog will help others fighting this dreadful form of Non-Hodgkins Lymphoma by providing information that I find in treatment of MCL and most importantly about our journey from diagnosis to remission to stem cell transplant and hopefully many years of living normal lives beyond. I look forward to sharing our journey through this journal with you. Gerry