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Rituxan, Flu and a Spike in Counts too ,,,

Posted Feb 26 2011 6:22pm

I've been holding off this post until I had enough new data to share to make it worthwhile, but  I didn't realize I'd get the flu while I was waiting.  Between treatments 6 and 7, I got hit hard with influenza B.  No doubt my youngest brought it home from daycare.  The youngest had a mild fever two days before I came down with it.  Fortunately, everyone (including myself) had been vaccinated earlier in the season, but since I've anilated my B-cells, there wasn't much benefit left from the vaccine.  I started feeling aches on that Saturday, but it didn't hit hard until Superbowl Sunday.  I got in bed around 10 am, couldn't really move and stopped drinking enough fluids.  Once my fever spiked to 102 around 3 pm, I called the NIH day hospital, and they asked me to come in.

I got to Bethesda around 4:30 pm.  They ran CBC, chemistry and cultures and hooked me up to an IV.  4 hours, 3 bags of saline and a digital X-ray later, I was good to go with Tamiflu and Tylenol in hand.  The next morning at 6 am, I started sweating profusely on my upper body.  At 7 am, I was awake enough to take off my T-shirt, which I could have rung out to get a couple cups of water in a bucket.

Needless to say, my counts spiked as shown below. I'm hoping the short term boost may have benefited my ADCC response to the Rituxan treatments too. It can't hurt to have all those extra neutrophils and monocytes available to recognize and target the hairy cells...

Lots of HCL patients have anecdotally commented that when they got viral infections, their counts improved. That was true in my case too, but it was very short lived. Still, my platelets seem to have gotten a significant boost, and are at the best level I've ever measured. Hopefully, that's a sign of good things to come.

I've got lots more to add to this post, including another potential treatment that uses a protein known as CD-19L --  a protein found on T cells that kills leukemia cells (specifically ALL in vitro) that express CD19.  Since hairy cells express CD19 too, I'm hoping CD19-L will bind to and destroy them. 

I also think HCL may be caused by RNA cytosine exposure to sunlight causing deamination to uracil and the subsequent HCL mutation.  Possible sunburn inflammation and exposure could be a cause.  Hairy cellers are generally in better shape than most people and seem to get lots of sun exposure.  White males and people with fair traits seem to have the greatest incidence of classic HCL.  Achkenazi Jews have greater incidence of HCL and express fair traits moreso than the general population.  (gotta go, but I'll clean this up and post more later).

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