Wednesday, December 12, 2007

December 12, 2007 - Two Doctors

Today I have encounters with two doctors: one on the phone, one in person.

Just after lunch, I participate – along with about 2,000 other people – in a teleconference sponsored by the Leukemia and Lymphoma Society. Then, late this afternoon, I stop by Dr. Lerner’s office for a port flush, a blood draw and a consultation.

The teleconference features Dr. Wyndham Wilson, a senior investigator and head of the Lymphoma Therapeutics Section of the National Cancer Institute. He’s reporting on the recent national meeting of ASH, the American Society of Hematology.

He begins by calling this, in language only a medical researcher could love, “a very exciting and optimistic time for the treatment of lymphoid diseases.” In other words, even though many forms of leukemia and lymphoma (including my own) may be incurable, there are a number of effective treatments now available, and more on the way, that can keep these diseases under control.

There’s chemotherapy, of course. And, for some patients, radiation. Those treatments have been around for a while. But there are also monoclonal antibody therapies, like Rituxan (that I received along with my chemo), as well as the sub-category of radioimmunotherapy (Bexxar and Zevalin). There have been major advances in stem-cell transplants, especially the mini-transplants the people at Hackensack were talking to me about. New idiopathic vaccine therapies are on the horizon (those true designer drugs, customized for each individual patient); several major clinical trials of lymphoma vaccines have just finished, and the oncology world is eagerly awaiting those reports.

Dr. Wilson points out that this is the tenth anniversary of Rituxan’s approval for general use. Ten years is not a long time. It’s such a short time, in fact, that no one really knows about the long-term success rate of this miracle drug. That story is still being written, and I suppose I’m one of the people helping to write it.

There’s a revolution going on in genetic research. “Gene-expression profiling,” Dr. Wilson says, is a method of looking at the output of actual genes. This profiling can minutely examine every single gene in a patient’s tumor cell. By figuring out which genes are turned on and off in which patients, researchers can gain a better understanding of how malignant cells actually work.

So, there are lots of reasons to be optimistic.

Fast-forward to later in the afternoon. Dr. Lerner comes into the examining room where I’ve been waiting to see him. He opens my file, and begins reviewing the results of my last CT scan, now nearly a month old. Previously I had received a message from him, by telephone, that my tumors are stable – no larger and no smaller than in the previous scan.

“Is this normal?” I ask him. “Is this something you see very often?”

Yes, he responds, it’s pretty common in indolent lymphomas. This disease sometimes advances in fits and starts. Its progress can stall for a very long time, in some cases. Sometimes for years.

He asks me to hop up on the examining table, and feels in the usual places for enlarged lymph nodes: by the neck, in the armpits, near the groin. Dr. Lerner tells me he feels some enlarged nodes in my armpit, a location they hadn’t been before. “Don’t be alarmed about those,” he reassures me. “They’re nothing to write home about.” They’re small, in other words. Still well within the realm of watch-and-wait.

The doctor quizzes me about how I’m feeling. Fatigue? Night sweats? Pain? I have none of these symptoms to report. It’s all good.

He tells me he’d like to see me in March, but I’ll need to come in for my monthly port flushes in the meantime. Call a month before that, and ask the office staff to schedule another CT scan, he instructs me.

No problem. I can handle that. My cancer is still in a relapsed situation, but its growth has slowed to a snail’s pace. Take your time, lymphoma cells. Take your time. I’m in no rush.

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