Monday, January 25, 2010

In the numbers - for Leslie

I'm posting these charts as examples of the response to Campath treatment.

In this first chart, you can see that Gwen's WBC was about 160,000 when she started. It continued to rise to about 200,000 before she reached full dosage, and then began a continuous decline to the normal range. It took less than 3 weeks to reach the normal range, and treatment was discontinued after only 4 weeks.

(In this first chart, the light blue (cyan) line is Campath dosage and infusion points. Click image for larger picture)

When Gwen relapsed in July of 2003, she waited until her WBC counts were about the same as when treatment started the first time. The response this time was immediate, and her counts went down even under the initial reduced dosage. They sort of plateaued for a week or so, then plunged to 0. We thought we had it beat again, but within days it had rocketed back up to 200,000, and Campath was discontinued and fludarabine was started. Now the counts really rocketed up, reaching almost 500,000 - that is, 50% of the blood being white cells. You can see how it drops off, goes up, and drops, and goes up - this reflects leukopharasis, not the fludarabine. Leukopheresis is filtering the blood to remove white cells, much like dialysis.

(In this second Campath is in blue, Fludarabine is the magenta "x" and the brown dots are "CHOP." Click image for larger picture)

It took one treatment of "CHOP" to take Gwen's WBC to normal and she walked out only days after I'd been told to make funeral arrangements. CHOP, however, is a "salvage therapy," only effective for a short time and resulting in destruction of the spleen.

Leukopheresis machine:

We had expected that a second treatment in the case of a relapse would be as effective as the first. It had been learned that the leukemia cells sometimes change from a CD52 to something else, and that makes Campath ineffective. Now, I can't tell you what that means, only that if you are reading this today in regard to a patient with T-PLL, you have options for transplant that were not available to us, and for this I am very happy for you.


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