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