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!