Day 31

Wow! Thanks for all the comments, ya'll. It's nice to know so many people are keeping up with me.

We have met such great people in our trips to M. D. Anderson. People here are all in the same boat, so it's quite easy to meet people. Over a year ago we met Merlin and Janie Cohen from Arizona. Janie had an extremely difficult melanoma on her head and underwent a very extreme treatment with Interleukin 2. She has just received an almost miraculous all clear checkup. Merlin is a former dentist turned sculptor. Check out his website at www.merlincohen.com.

Terry and Linda Irvin are from Pennsylvania. I met Terry in May while he was good naturedly harassing one of the leukemia nurses. He and I have been tracking along about the same, but he got ahead of me by about 3 weeks with his bone marrow transplant. He is a general contractor and golfer, so we have a lot in common. This summer when I was here getting chemo, Terry, who spent most of the summer here, was getting an abdominal lymph node biopsy. This procedure involved a long needle through the back. Because they had to knock him out to do the procedure they had to have someone sign him out and help him out of the hospital. He was here by himself at the time, so Merlin Cohen and I went and got him out of the hospital. We three ended up hanging out together for several days. I see both of them frequently when I'm here, although Merlin and Janie won't be here much, hopefully, in the future. I see Terry several times a week at the ATC.

Now we have met Anna and John from Austin. Anna left a comment on my last entry to the blog. They are an amazing couple and a lot of fun to be around. I first met them making the rounds on the 11th floor of the hospital. John has AML and has received a stem cell transplant with his brother as the donor. They have another member of their family here with them, Dillon, John's seeing eye dog. John is a great inspiration to me.

Then there are the myriad of other people we have met but haven't had the opportunity to know as well. There's the little middle eastern girl who is always here at the Rotary House dressed in pink. We met a couple on the Rotary House shuttle bus last week from Jackson, Mississippi who has family in Atlanta. Doug, the husband, played football at Tech in the late 60's and is an architect in Jackson. The list could go on and on. Plus there are the nurses and doctors who have great stories in their own right. One of the APN's (advanced practice nurse) who came in to check on me the other day in the ATC had on a cap covering her bald head. I gently joked to ask her if she was undergoing chemotherapy or just trying to make the rest of us feel better. She is indeed participating as both patient and nurse.

So the people are truly fascinating. I have said from time to time that I don't know if this is nightmare or an adventure.

Changing subjects, I must have confused everyone with the monoclonal antibody stuff. So let me clarify it a little.

Our bodies produce antibodies to fight off specific bugs. That is why adults usually don't get the strep throat that their kids get. The parent's body has seen strep before and has produced antibodies that will kill strep next time it tries to invade. That is why we get vaccinations, too, to introduce a little bit of a bug to our systems in order to make our immune systems produce antibodies to fight off the real bug when it comes along.

It has been theorized that our bodies could possibly create antibodies to fight off specific cancer cells. That hasn't really materialized, but in the 1970's artificial antibodies were produced inside mice that would attack certain types of cells. Once these antibodies were perfected using both mouse as well as human DNA, they were cloned. And they are cloned from one certain antibody. Hence, mono, for single, and clonal for cloned. This is what a monoclonal antibody is, an antibody cloned from a single type of artificially produced antibody.

How many monoclonal antibodies are there? You can google "monoclonal antibodies" and get a lot of information on them, but there are roughly a dozen of them that have been developed so far.

What kind of cells do these antibodies attack? Researchers have found that cells have various protein molecules on their surface. The proteins are named CDxx, where the xx represents a number. CLL (chronic lymphocytic leukemia, the disease I have) cells have a protein on them called CD20. Also some CLL cells have CD52 on them. AML cells have CD33 on them. There are even more proteins than these.

So the monoclonal antibodies have been "programmed" to go after cells that have specific proteins on their surface. Rituxan is one monoclonal antibody that I have had numerous times that targets cells that have the CD20 protein on them. Fortunately, very few healthy cells have CD20 on them, so Rituxan is very good at seeking out and killing just CLL cells. To use a military analogy, Rituxan is like an immunological sniper.

Campath is another monoclonal antibody I have had that targets cells with the protein CD52 on them. CLL cells have that protein on them also, but so do some healthy cells. So Campath is not as targeted as Rituxan. It kills CLL cells, but also some good cells.

Lynda's uncle, Alfred, has taken another monoclonal antibody, Mylotarg. Mylotarg targets cells with the CD33 protein on them. Apparently CD33 is on the surface of AML (acute myelogenous leukemia) cells. Last report is that they didn't find any trace of the disease in him.

So, now are you thoroughly confused?

Today was something of a milestone day in that I had a CT scan and a bone marrow biopsy to determine how well the transplant is working. It will be a few days before the results are available. It will be about 2 weeks before we will know what percentage of the bone marrow is comprised of the new system versus my old system. The new stem cells have to create new blood and a new immune system to attack the disease and wipe out the remainder of my old system. So that is the battle going on inside me right now. No wonder I'm a little tired.

I only have to go to the ATC on Monday, Wednesday, and Friday now. I still get a daily infusion, but on the "off" days I hook up the infusion myself in the hotel room using a little portable pump in a bag. So tomorrow, Tuesday, is an "off" day.

Today was a long 11 hour day starting with bloodwork at 6:15, followed by the CT scan (with barium for breakfast), the usual infusion, and a long needle in the hip (bone marrow aspiration and biopsy), and then topped off by a Neupogen shot. I wheeled my IV tree down to the 7th floor to get the bone marrow biopsy while hooked up to the IV. I'm a little sore tonight from the Neupogen, but especially from the bone marrow biopsy, which now feels like I've been kicked in the rear by a horse. Pretty typical, but it will be a lot better tomorrow.