Get Your Game Face On

Developments have come quickly for JoAnne. There were no treatments today, but she will be admitted to the hospital tomorrow at noon. The original plan was to treat her with a monoclonal antibody (names end in mab) called rituximab, otherwise known as Rituxan. As noted in our previous post, she had adverse reactions to it in the past. Option 2 was ofatumumab, also known as Arzerra or Hu-Max CD20. It sounds as though the doctors have been able to convince the insurance company that we should proceed directly to Option 2. Let's have a high five for the salesmanship of the doctors and the insurance company. This potion is spendy.

Monoclonal antibodies work by targeting, attaching themselves to and destroying cancer cells. Ofatumumab (doesn't it just roll off the tongue?) is a fully human antibody while rituximab is a chimeric antibody comprised of human and mouse components, hence its nickname of "mouse juice" in patient circles. It may be that JoJo, like a segment of other patients, was allergic to the mouse component. If you have ever seen her in the presence of the little rodent, this will not surprise you.

JoJo will be admitted to the hospital so that they can keep close eye on her for any adverse reactions and treat them promptly. These are not uncommon and can usually be dealt with by slow intravenous administration of the agent. If all goes according to plan she will go home Thursday. Subsequent doses will be of higher volume and administered weekly. We can't tell you for how long right now. Her risks of infection and complications will again likely increase. Depending on how she responds, she may be able to receive infusions without a hospital stay. 

JoAnne awoke today feeling very depressed. We both had begun to move into the healing phase and now it is right back in the breech; back into treatment phase. In my mind, I picture a barrel that is 80-90% full of a toxic sludge. Through the miracle of stem cell transplant, the sludge is within one small drop of completely disappearing. But not before a quirk of nature triggers this one small drop to spawn another form of sludge, more toxic and much more aggressive. It is as though JoJo has traversed the Valley of the Shadow of Death only to step on the one single land mine left buried in the whole flippin' valley. Sometimes 4 of a kind gets trounced by a straight flush. Had enough metaphors?

I woke up cranky. In younger days when energy was near boundless, I could hold onto anger. But anger is draining and it saps one's energy quickly. As I have aged, my gas tank doesn't seem to hold as much fuel, which is curious because it sure looks a lot bigger than it used to. The point being that anger consumes too much valuable energy and is rarely productive. I regret that I did not take heed of this truth a long time ago. It is better to let go and use your energy to focus on the positive. Remember? God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference. But how does one let go of experiences like this? This is evil. It is an absolutely helpless feeling. For a time.

We have our meditation mantra. Hope for the best. Prepare for the worst. And we have a dedicated team at the UMn BMT Clinic with a new monoclonal antibody jetting in via overnight express. In most cases, diffuse large B cell lymphoma is not detected until it is firmly established in the lymphatic system where it is then difficult to treat. Maybe we just got plain lucky in that the new cancer began percolating just as the highly precise PET scan was done. Right now it may be so small and localized in the bone marrow that it can be rapidly obliterated. Until I hear different, that's my story and I am sticking to it.

JoAnne is also strengthened by her deep and abiding faith in God, and the support of family and friends who comfort her through their faith, love, thoughts, deeds and prayers. You are a power to be reckoned with. Hand in hand, arm in arm, we can get through this new challenge.

Cancer sucks