Post Number 7

Unlike Chronic Lymphocytic Leukemia (CLL), Acute Myeloid Lymphoma (AML) does not affect just older individuals. It is the most common form of leukemia in adults and has similar symptoms to CLL, but is not a chronic disease so it frequently targets young adults (ages between 20 and 40). At the clinic, there a man in his thirties had been diagnosed with an aggressive form of AML. At first, doctors decided to use the wait and watch method to see if the disease worsened. Eventually, they decided that the best form of treatment to use was a stem cell transplant. During the appointment, they discussed possible donors and chemotherapy treatment needed after the procedure to help him recover from the stem cell transplant. The man was told that the drugs necessary for his treatment would most likely harm his ability to reproduce, and as you can imagine, he and his wife did not take the news happily. Of all the patients with difficult stories that I have been able to meet, this patient’s dilemma was the most impactful because of how young he was. Watching a new, young couple being told that they may not be able to have their own children put me in a state of sorrow like none of the other patients’ stories had.

As for the evaluation of the treatment for the patients with Relapsed/ Refractory CLL, the two patients’ data is enough to know how long the treatment process is. One patient was unfortunately unable to complete treatment, so the study is only of two patients. Both patients are female over the age of 65 that were diagnosed with CLL from two to three years ago. The first patient’s White Blood Cell (WBC) count never reached the level of the second patient, yet had much more swollen lymph nodes. Patient one was previously diagnosed with Small Lymphocytic Leukemia (SLL) in 2003, yet returned in the form of CLL. Her treatment began immediately due to the occurrence of symptoms like weight loss and lymphadenopathy. Although patient two’s WBC count was twice as large as patient one’s, her treatment started a year after diagnosis because she did not have extreme lymphadenopathy. The two patients’ treatment is continuing, yet as of now patient one has had a partial response to the novel treatment and patient two had a complete response to the treatment.

Thank you all for taking time to read my blog. Again, if you have any questions, please leave a comment. Otherwise, have a great day!

Patients Always Somehow Remain Optimistic

Graft versus Host Disease (GVHD) is a disease that comes from complications after a stem cell or bone marrow transplant. The donated stem cells begin to attack the recipient’s body and can lead to things like muscle weakness, yellowing of the eyes, rashes on the skin, and weight loss. A patient between the ages of 50 and 60 recently had a bone marrow transplant, and ultimately GVHD, causing him to be extremely thin and unable to raise his left leg. Another man in his seventies also had GVHD and muscle weakness/ fatigue, however he had gained weight because of his inability to exercise. Despite the side effects and pain that these two men have to endure, they were both in good spirits and had a great outlook on life. Rather than being sad about their diseases, they remained optimistic about their chances to beat their leukemia and continue with the lives that they love.

Another man between 45 and 55 had an aggressive form of chronic B-cell lymphoma and a hard time hearing either me or the doctor. Although at first he was extremely quiet, he began to talk about the things that brought him joy in his life, such as his soon-to-be wife and his high school hobbies including wrestling and football. He and I talked about sports for around 15 minutes during his appointment and I could see that he became more and more comfortable with the situation that he was in. The more and more we talked, I began to forget that he was a patient with leukemia because he spoke as if there weren’t any problems in his life. Seeing these strong minded patients persevere through their life threatening diseases with an open mind and a happy heart is truly inspiring. 

Thank you for taking time to read my blog once again. If you have any questions, feel free to leave me a comment. Have a nice day!

What is CLL?

Although I have already posted about possible Chronic Lymphocytic Leukemia (CLL) treatments, I have left out some background information on what CLL is, who it affects, and what the requirements for remission are.

CLL is the most common form of leukemia in Europe and North America, and is mostly only found in older adults, the median age for diagnosis being seventy years in males and seventy-four in females. Since it is a chronic disease, it almost never affects children, and is fairly uncommon for individuals under fifty years old. CLL can start when there is a mutation in the DNA of one marrow cell and then this marrow cell matures into a B lymphocyte. This malignant B lymphocyte or B cell begins to proliferate uncontrollably, which is called lymphocytosis, and hinders the production of other blood cells, such as red blood cells, causing anemia. The cluster of lymphocytes is what causes lymph node swelling because lymph nodes are areas of high lymphocyte concentration. In order for a patient to be diagnosed with CLL, there must be at least 5x10^9 B lymphocytes in a sample of the patient’s peripheral blood and there are other ways to diagnose a patient.

In a previous blog post, I went over various CLL treatments and their general mechanism of action and those treatments are of course to try to achieve cancer remission. As a patient continues through their long battle with cancer, he or she has blood drawn regularly and that blood is examined in a lab to monitor blood cell count. Since CLL is a proliferation of leukemic B cells, the main goal of treatment is to lower the amount of B cells in a patient’s peripheral blood back to normal amounts. For a patient to have complete remission, he or she must have a lymphocyte count in peripheral blood below 4x10^9, neutrophil count above 1.5x10^9, platelet count above100x10^9 hemoglobin above 100 G/ L, lymph nodes no bigger than 1.5 cm in diameter, and a non-significant enlargement of the spleen two months after active therapy has been completed. Many patients don’t ever reach complete remission, and instead have relapsed or refractory CLL. Refractory CLL means that the patient had treatment failure and a recurrence of symptoms within six months of treatment completion and relapse refers to a patient who had reached complete or partial remission, yet begins to develop symptoms more than six months of treatment completion.

Thank you for taking time out of your day to read my blog once again! If you have any questions about what CLL is, please leave a comment below. Have a great day!

Independent Research on Ibrutinib and Meeting New Patients

After researching more on Ibrutinib, I have been able to find more information on Bruton’s Tyrosine Kinase (BTK) and the mechanism of action of Ibrutinib.  BTK is found on all B cells and works as a relay of proteins in transmits signals like a chain reaction to tell other cells to multiply, so it can become problematic when BTK is expressed on leukemic B cells. In CLL cells, BTK is often over expressed and can lead to an increase in the number of CLL cells and their lifetimes. B-cell receptor (BCR) signaling is a chain of signals involving a variety of molecules in order to carry out functions like cell growth and differentiation, and is overly activated in CLL cells. Down the line of the BCR signaling chain is BTK so inhibitors like Ibrutinib attach to BTK permanently and hinder its signal transmitting function.

I had the chance to meet new patients in Dr. Anwer’s clinic. One woman between the ages of 45 and 55 had a form of Acute Lymphocytic Leukemia (ALL). A side effect of her leukemia was an unequal distribution of upper body mass and lower body mass. The woman had a very thin upper body, yet her legs were extremely swollen. On top of that, when her leg was pressed with a finger, it would keep a finger imprint similar to pressing down on a foam mattress.

I also had the privilege to meet with patients who did not have leukemia themselves, yet were donating bone marrow for leukemia patients. I soon realized how much the donors had to be responsible for, such as their own diet and exercise routine to ensure their bone marrow is healthy and that their post-donation recovery goes smoothly.

Thank you for taking time out of your day to read my blog. Once again, if you have any questions, leave a comment below. Have a great day.

Meeting New Patients

After having shadowed Dr. Anwer at his clinic a couple of times, I have come to find that he is an extremely busy doctor. It seems as if the list of patients that he sees in one day is endless and he somehow remembers everything about them, from their treatment regimen to how their family is doing. But I had the privilege to go around and meet a few patients and learn more about different treatment regimens and side effects to Leukemia.

One patient that I met was a female between forty and fifty years old and had been diagnosed with an acute form of Leukemia a couple of years back. She described her pain as being ten out of ten and unbearable, yet she was also suffering from severe depression, so her pain may have seemed worse than it may have been. She also felt extremely nauseous from all of the drugs that she has been taking daily and had poor nutrition. She did not want to eat much, if at all, because she feared she would vomit. Ina addition to seeing the effects that cancer has on someone physically, I also got to see the mental and emotional toll in takes on patients and their families.

Some patients had trouble staying healthy after their bone marrow transplants. Two patients experienced weight gain because the new stem cells had not matured enough causing them to feel weakness. This limited their ability to go out and perform simple exercises such as walking, and caused them to gain weight.

Another patient was a woman between fifty five and six five years old who had a bone marrow transplant five to six years ago. Her blood counts are normal and she experiences no intense pain, yet a side effect of her transplant was scleroderma. Scleroderma is a thickening of the skin that is common in leukemia patients after they have had a bone marrow transplant. It is difficult to try pinch the skin of a patient with scleroderma and the patient can feel stiffness and pain at times.

The main takeaway I received from meeting new patients is the amount of work and commitment necessary to try to fight back against cancer. Each patient had their own schedule in which they write how much of a certain pill they took and during what time of day. The amount of drugs that each of the patients was prescribed to take was really surprising and gave me insight as to how tedious this treatment process is, especially with CLL that can go into remission and return so easily and often.

I look forward to continuing with my project, conducting my own independent research, and shadowing Dr. Anwer. I look forward to meeting new patients and learning about their unique stories, situations, and issues. Thank you for taking time out of your day to read my blog, and if you have any questions, feel free to leave a comment below. Have a nice day. 

Current treatment regimens for CLL and background to Ibrutinib, Rituximab, and Methylprednisolone

Today, there are several options to treat patients with Chronic Lymphocytic Leukemia (CLL). If the patient does not have extreme symptoms, like swollen lymph nodes and spleen shortly after diagnosis, the first step in treating CLL is the wait and watch method. Instead of administering drugs immediately, the best approach is to monitor blood cell count and to see if the disease worsens. Research studies show that there is harm for waiting to begin active treatment because some patients may not develop severe symptoms for an extended period of time, and may not need any treatment at all. If the symptoms worsen, then active treatment will begin, usually in the form of chemotherapy. The most common drug used in CLL chemotherapy treatments is Fludarabine, a purine analog that helps to inhibit the function of DNA polymerase and ribonucleotide reductase and promote apoptosis or programmed cell death for cancer cells in the blood. When compared to other drugs that may be able to function the same way, Fludarabine proved to be more effective with higher response and remission rates in patients with CLL.

An alternative to chemotherapy and Fludarabine is targeted therapy. Targeted therapy is a method of treatment in which a drug targets the leukemia’s specific genes or proteins. One example of targeted therapy is the use of monoclonal antibodies. Rituximab, one of the drugs that will be used in my Senior Research Project, is an anti-CD20 monoclonal antibody that is able to attach to an a surface protein on B cells, and can destroy CLL cells without harming normal B cells. Due to the success that Rituximab has had, it has been used in combination chemotherapy with Fludarabine.

Ibrutinib is will also be used in my research project and is a kinase inhibitor (another type of targeted therapy). A kinase is an enzyme found in both cancer cells and normal cells. Ibrutinib targets Bruton’s tyrosine kinase which is very influential in the growth of B cells. Ibrutinib is able to block this enzyme, therefore destroying some CLL cells. In recent studies, Ibrutinib seems to be more effective (higher response and remission rates) when combined with Rituximab.

            The last drug to be used in this project is Methylprednisolone, a corticosteroid that helps to prevent substances that promote swelling in the body to be released. This can be extremely useful to help reduce swelling of the lymph nodes (adenopathy) and the spleen. This steroid is mostly used in patients with Relapsed CLL (CLL that has returned) and has shown to increase response rates in Relapsed CLL patients when combined with Rituximab. If the patient does not respond well to Methylprednisolone and spleen swelling persists, the patient will most likely have to splenectomy (spleen removal).

            Chemotherapy and the other drugs discussed come with side effects, mainly nausea. If the leukemia persists and a patient is resistant to a drug, he or she may need a stem cell or bone marrow transplant where leukemic bone marrow is replaced with specialized stem cells that mature into healthy bone marrow. This procedure can be extremely painful and can also be unsuccessful often.

            The three drugs to be used in my research project have been tested and are used currently. Rituximab has been combined with Ibrutinib and Methylprednisolone separately and has shown success, but the three have not really been combined in the treatment of CLL.

Introduction

Hello everyone! My name is Eric Arellano and I am a senior at BASIS Tucson North. During the final trimester of this school year, my fellow classmates and I will be interning at an off campus site of our choice and performing a Senior Research Project (SRP). The SRP allows us as seniors to have an opportunity to gain experience in fields that we find intriguing and create a final product.

I will be interning at the University of Arizona North Campus Cancer Center with Dr. Faiz Anwer, who is a Medical Oncologist at the Cancer Center. I will be completing a project that pertains to Chronic Lymphocytic Leukemia and conducting my own research.

With the help of my advisor, I will be evaluating how effective the combination of three drugs (Rituximab, Ibrutinib, and Methylprednisolone) are at treating Relapsed or Refractory Chronic Lymphocytic Leukemia. The combination of these three drugs is a novel regimen, meaning it has not been attempted before. We will be monitoring blood count and checking for possible side effects and infections caused by using the three drugs.

I am extremely excited for the opportunity to work with a medical oncologist and experience what the medical field is like. If you have any questions for me about my blogs, leave a comment below.

Thank you for your time!

Eric