Final Weekly Visit

 Sitting at Detroit Metro Airport right now, waiting to board my Delta flight to Houston, and I've had a little time to reminisce on treatment thus far.

In short, I don't things could possibly be going better than they are. The results are, thus far, tremendous. Blood counts are normal across the board - WBC, RBC, hemoglobin, platelets....and all the rest of them are normal. I'll take a more detailed blood test and bone marrow biopsy sometime this summer to get a more detailed look at how many CLL cells per 1 million blood cells (if any) remain in my bloodstream and bone marrow, but in the meantime my blood tests suggest the following:

1. Most, if not all, CLL cells have been cleared from my bloodstream (huge)

2. My bone marrow is also clearing. This is important because marrow is the last section to clear (after blood stream and lymph nodes). If the marrow was still crowded with CLL cells, my RBC and hemoglobin would likely be abnormally low (because they're crowded out). Further, this would suggest a shorter remission as the abundance of CLL in my marrow would soon multiply and return to the bloodstream. 

Who knows? I might be in remission already. What my elite early response also suggests, is that I'll likely be in a complete remission when all is said and done. In other words, undetectable cancer in the bloodstream and bone marrow. This would point to one of two outcomes:

1. Many years of remission, followed by a slow relapse and even more effective (maybe curative) therapies available when I need them in the future OR

2. A functional or true cure. Meaning we either got every last CLL cell (less likely) or we got just about all of them, and all that remains are weak ones that my immune system can contain (more feasible). The doctors at MD Anderson believe that the treatment I'm receiving will end up being a cure for some patients - why not me?

I realize, oh loyal reader, that I've been posting less frequently over the past month or so, and it mostly has to do with how clinically uneventful these Houston trips have become. I head in, get a blood test, sit around and wait for the reults, get great news, and head home. Rinse, repeat.

I've also learned that, as far as cancer appointments go, boring is good. I want these appointments to be as mundane and ho-hum as possible, and that's exactly what I'm getting.

And now I board the flight. Excited for this one, as I'll be able to watch the Michigan/Michigan State game in its entirety as it starts about 15 minutes after this flight takes off. I've reunited with some extended family in the Houston area, and they'll be waiting for me when I land.

Go Spartans!

Normal Counts and Sonic in my Bloodstream

 It's a beautiful day in East Texas, and the good news keeps coming - save for one scheduling snafu. I got in Sunday night, took the bus(es) to my hotel, then woke early this morning to go get a blood test. The blood test results are excellent, as my white blood cell count and absolute lymphocyte count are both in the normal range for the first time since before I was diagnosed. From what I understand, this is excellent news and means I'm well on my way to a complete remission - though it would be premature to unfurl the "Mission Accomplished" banner and give a speech.

As I was discussing the results with Meghan, the well-informed PA who works with Dr. Chien, she informed me that there was a scheduling miscommunication, and that I'd need to fly out Wednesday instead of tomorrow. "You could use the extra day to go for a long run around Houston," she suggested.

I saw an opportunity.

"Call me crazy if you will," I began, "but I have this unproven theory that if I routinely go running after taking the venetoclax and pirtobrutinib, that I'll be increasing my heart rate, stimulating blood flow, and distributing the drugs in and out of the lymphatic system, the bone marrow, and other harder-to-reach areas that CLL cells are known to hid in. This would - according to my unproven theory - lead to a deeper remission and a higher likelihood of getting every last CLL cell. Can you speak to this idea?"

Meghan's eyes widened (we both had masks on as it's required) and she paused before responding. "That's a great question!" She replied. "We don't get many marathon-runners in here, but I can see where that might make sense biologically."

That's all I needed. I went out and ran 10 miles right after the appointment. While I was running, I kept imagining that the little pirtobrutinib and venetoclax molecules were little Sonic the Hedgehogs. It's probably been a while since you've played that game, but my kids have gotten into it recently (you can play for free online HERE) and I've played with them.

In the game, Sonic runs around with his buddies Tails and Knuckles, gathering rings. I imagine that's pirto, ven and obin, running through my bloodstream and picking off CLL cells. Sometimes, Sonic can get a hold of his magic red shoes, which speed the game and music up like 5x, and Sonic and co. gather rings at lightning speed. That's what's happening with PVO when I run - Sonic's magic shoes, baby.

Good to Great

After a two-week hiatus, I returned to Houston on Super Bowl Sunday, missed a lackluster game, and headed back into MD Anderson Monday morning. I no longer feel like an out of towner, not in the Rice Village/Texas Medical Center anyway. I've got a routine down, know how to get here and there without Google Maps, and Devin the Dude pops up routinely on my Apple Music "Sean's Station". The algorithms know that I know what's up in H-Town. I'm also strengthening my feeling toward the Rockets (positive - going to the game tonight) and the Astros (negative - glanced at their howe schedule in March/April and I just can't imagine wishing them well).

Go Rockets

Anyway, let's start with the cancer battle though as I have good news there. I had a blood test this morning, followed by a Dr. Chien appointment - I hadn't seen her since the day before treatment started, and when my cancer was at its peak. We chatted about running and marathons and whatnot, which is typical for us. She informed me she's running the NYC half marathon next month for Blood Cancer United, and that this move was inspired by me and the Marshall Michigan Ramblers. I informed her that I'll be joining her at the Houston Marathon in January 2027. At some point, I asked "should we chat about CLL?"

"Oh yeah!" She said, as if we almost forgot to visit this topic. "Your blood test results are excellent," she started. Dr. Chien proceeded to explain to me that, one month into a 13 month trial, I'm sitting on a best-case scenario. The cancer burden has been dramatically reduced, my body is clearly tolerating the drugs well (pirtobrutinib and obinutuzumab, that is), and my outlook is very optimistic. She told me that, while she can't predict the future with certainty, she believes that I'll be at uMRD6 by the end of this trial. "uMRD" meaning "under minimal residual disease", and the 6 meaning no CLL cells detected out of a test of one million blood cells - the most sensitive test available nowadays. 

I start a new drug today - venetoclax - which I'll take as soon as I'm done typing this blog post. In keeping with my 2004 Detroit Pistons analogy, if pirto and obin represent the Pistons team at the start of the season (winners), then venetoclax is Rasheed Wallace - a midseason acquisition that turns a good team into champions. Where pirtobrutinib blocks survival/reproduction signaling and flushes CLL out of its hiding niches, and obinutuzumab recruits the immune system to destroy CLL in the bloodstream, venetoclax gets into the bone marrow and other hard-to-reach areas, pushing CLL cells into apoptosis (programmed cell death).

While each of the three drugs (P, V and O) have been studied individually, the clinical trial I'm a part of here at MD Anderson is determining how well they work together. CLL has gone from "incurable" to "manageable" over the course of the past 10-15 years, now the question is "if we combine therapies and drive the disease to uMRD levels, how long can remissions last? 5 years? 10 years? Indefinite?" We shall see if this PVO combo is a championship team, and the early results indicate that it is.

Ok, I'm gonna take this venetoclax, then head to MD Anderson for an obin infusion. From there, I have another blood test, then grab something to eat before I head downtown to the Rockets game. 80 degrees and sunny down here!