PD-1 Approved

12/28/15 –Bristol-Myers Squibb contacted me today to notify me that I have been approved to receive a year supply of the PD-1 drug known as Opdivo. This, of course, is awesome news.

So what is OPDIVO? Here is some information from the Bristol-Myers Squibb website:

OPDIVO® (nivolumab) is a prescription medicine used to treat a type of advanced stage lung cancer (non-small cell lung cancer) that has spread or grown and you have tried chemotherapy that contains platinum, and it did not work or is no longer working. OPDIVO is the first and only immunotherapy the FDA approved based on two clinical trials that resulted in longer life for adults 
with advanced NSCLC previously treated with platinum-based chemotherapy.

How is OPDIVO different from chemotherapy?

OPDIVO is an immunotherapy treatment. It’s a type of medicine that works with your immune system.

What does the immune system have to do with cancer?

Your immune system is designed to protect your body from external threats like viruses and foreign bacteria, and internal threats like cancer cells, including lung cancer. However, some cancer cells escape from the attack of the immune system by sending specific signals. Immunotherapy treatments can work through the same signals to help the immune system in the fight against cancer.

This emerging area of medicine is called immuno-oncology, a field that is helping doctors and scientists understand how immunotherapies like OPDIVO may help the immune system to fight cancer.

The plan for me is use OPDIVO against my Mantle Cell Lymphoma. Although there is not a lot of data on how effective it will be with MCL, my doctors feel the science is excellent and they expect to see similar results with MCL as has been observed with lung cancer. I am waiting to hear from Dr. Goy and Dr. Rowley of the plan to provide OPDIVO to me. Maybe I will hear a little about it when I am at the Cancer Center on 12/31 for my follow-up appointment.

I am excited for the opportunity to be a part of this cutting edge treatment. Sure I hope it works from me, but also it would be fantastic if this leads to something that helps other MCL patients.

Therefore I tell you, whatever you ask in prayer, believe that you have received it, and it will be yours.

Mark 11:24

More to come…

http://mantlecell.blogspot.com/

A GVHD Sighting

12/17/15 – I had my follow up appointment at the Cancer Center today and, believe it or not, I am showing some signs of a GVHD rash. My forehead, cheeks and neck are the most impacted areas. I will have to say my neck is the worst part because it is so darn itchy. The plan is to hold off on DLI for a few weeks to see if the rash will move to my whole body. If it does, it is not likely I will need another DLI anytime soon. Also it will mean that my GVHD will need to be treated. When and if, the full rash appears I will be prescribed prednisone.

Another big event of today is that we resumed my immunizations. I received 5 shots which included DTap, Hib, Hepatitis B, Polio and PCV13. These were all scheduled as 15 month immunizations. I guess it’s better late than never. The good news is I am getting back on track with the SCT plan from 2013.

Lastly, I have been contacted by  Bristol-Myers Squibb this week to advise me that they received all the paper work from our appeal. They will be reviewing it to see if they can approve me. I should hear back from them within a week.

All and all this was a great day. I am looking forward the a great Christmas and Holiday season.

Here is a link to a great song by the David Crowder Band call “Go Tell it on the Mountain”.  https://www.youtube.com/watch?v=8uY7W1kYlX4

Also here is a link to Matt Maher singing “Silent Night”.

https://www.youtube.com/watch?v=hAxgOvJh-Tg

This should help get you in the Christmas Spirit. Enjoy!!!

For unto us a Child is born, Unto us a Son is given; And the government will be upon His shoulder. And His name will be called Wonderful, Counselor, Mighty God, Everlasting Father, Prince of Peace.

Isaiah 9:6

More to come…

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A Time to be Thankful

11/25/15 – Last year on Thanksgiving Day I celebrated my 1 year anniversary of my stem cell transplant. As I approach my 2^nd anniversary (or what many consider my 2^nd birthday) it is very clear that so much has happened over the past year. Yes, I relapsed… Yes, I had challenges handling my chemo therapy… and Yes, I am still waiting for any type of sign that shows I have an immune system that can fight my mantle cell lymphoma if it tries to come back again.

BUT… I am alive to fight another year… and although this past year has been a road full of many bumps, there were also many fantastic times along the way. And Yes, although there were times that I was sick and weak from treatments, it was always amazing how my family and friends were always there for me, my wife and my daughters.

And with all this said, I am in full remission, I have returned to work and I am living my life as a happy and healthy person. It is times like these that makes you appreciate each day as a wonderful gift. It is important that we live life a day at a time… better yet, we live life a moment at a time… making the best of each moment.  

I am truly very blessed to have such a loving and supportive wife… and daughters who are willing to drop everything and be by my side. I certainly have a life where I am surrounded by love. True I have been fighting MCL for over 7 years, but I can say without any hesitation that God has been very good to me. I have so much to be thankful for.

I would like to wish everyone a very Happy Thanksgiving to you and your families.

God truly loves us all. Here is a link to a song called “How He Loves” by the David Crowder Band that I think you will enjoy.

https://www.youtube.com/watch?v=2FxaUYjRtkc

Come, let us sing joyfully to the LORD; cry out to the rock of our salvation.

Let us come before him with a song of praise, joyfully sing out our psalms.

For the LORD is the great God, the great king over all gods,

Psalms 95:1-3

More to come…

http://mantlecell.blogspot.com/

I finally had my 2nd DLI today

11/12/15 – After a few delays, I finally had my DLI today. The plan is to wait 4 weeks to have a follow up appointment being it typically takes 4-5 weeks to see any impacts of the DLI. My next appointment is scheduled for December 10^th. If at that point there are no signs of GVHD, then another DLI will be scheduled. If there are signs of GVHD, then the GVHD will be treated. Once GVHD has successfully been treated then another DLI will be scheduled. This pretty much an ongoing process that will be followed until my immune system and my body come to terms with each other. It will probably take a long while before I get there. In the meantime, the hope is that my agitated immune system will be able to fight out any new MCL that comes its way. I sure know this is confusing stuff. Dr. Rowley does the best he can to explain everything to my wife and I. At the end of the day I have totally trust in him and his team.

Along with our busy DLI Day, today we handed in all our paper work to the oncology team to appeal denials from my insurance company (Aetna) and the drug company (Bristol-Myers Squibb) for a PD-1 drug called Opdivo (nivolumab). Our hope is that I finally get approved and that we add it to our arsenal of treatment options. We have certainly heard great things about this drug. 

“For God shows no partiality.”

Romans 2:11

More to come…

http://mantlecell.blogspot.com/

More Obstacles Present Themselves

11/6/15 – My DLI has been rescheduled for Monday, November 9^th. Unfortunately I am running a high fever (102ish). I also have a sore throat and cough. If I cannot get well it is very likely that my DLI will need to be delayed yet again. 

Blessed is the man who remains steadfast under trial, for when he has stood the test he will receive the crown of life, which God has promised to those who love him.

James 1:12

More to come…

http://mantlecell.blogspot.com/

DLI Put On Hold

10/26/15 – Today I went to The John Theurer Cancer Center at Hackensack University Medical Center for my DLI and believe it or not we were not able to go forward with it. I have had an eye irritation over the past week and apparently dry eye is a possible symptom of GVHD. Although it is not a strong enough reaction to know it is definitely GVHD, Dr. Rowley decided it would be best to wait and see what develops over the next week. I innocently asked “what’s the harm if I had the DLI even though there may be a GVHD response developing?” Dr. Rowley’s answer was extremely “eye” opening. He said “its like throwing gasoline on a fire.” All I can say is YIKES!!! I guess it is an excellent idea to wait and see if a rash or any other GVHD symptoms show up over the next week.

I was able to schedule an appointment with an Ophthalmologist. After a thorough eye examination is was found that I had a slight case of dry eye in addition an eye irritation. I was prescribed an eye salve that should address the irritation and some eye drops that should relieve any burning and itching I have in my eyes.

We have rescheduled an appointment at the Cancer Center for Monday, November 2^nd. If GVHD does not make a stronger appearance at that point we will then go forward with the DLI. In addition I have a follow-up with the Ophthalmologist on Tuesday, November 2^nd.

So it is back to waiting and watching… Saying this, I am feeling great and thrilled to be headed in the right direction. I am so blessed to have such great family and friends who have been so very supportive and who have provided their non-stop prayers for me to get well.

And whatever you ask in prayer, you will receive, if you have faith.”

Matthew 21:22

More to come…

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Remission Accomplished!!! … Again!!!!

10/13/15 – On December 12^th 2008 I reported that I had achieved remission. On October 28^th 2013 I again reported that I had achieved remission. Today, October 13^th 2015, after meeting with Dr. Goy, I am again happy to report that I am in remission from my Mantle Cell Lymphoma.  All I can say to this is: REMISSION ACCOMPLISHED!!!! …. AGAIN!!!!

Will this third time be a charm for me? I certainly hope so. One way to help ensure that I stay in remission would be to make sure my immune system is strong enough to fight off disease. At this point in time it is not believed that my immune system is strong enough. This is where Graft Versus Host Disease (GVHD) comes into play. GVHD is the evidence we are looking for to show that my immune system has the ability to ward off any and all outside illnesses, infections, diseases, etc... Unfortunately since my stem cell transplant, back on November of 2013, I have never developed any sign of GVHD. We again tried to force GVHD by having a DLI on August 3^rd but that too appears to have failed in getting any GVHD. Our current plan of attack is to attempt to bring on GVHD by having another DLI on October 26^th. GVHD reveals itself in the form of a rash. As strange as it may sound we are praying for me to get a rash.

During my appointment with Dr. Goy today he mentioned that he will also be looking give PD-1 another try. It seems that it is starting to be used and be more accepted as a treatment for Mantle Cell Lymphoma. He feels more confident that he can get me in a trial/study as well as getting it approved through insurance. If this does happen I will be getting PD-1 treatments once every two weeks… more to come on this.

Up next for me… I have a follow-up/pre-DLI appointment with Dr. Rowley, my transplant doctor, on Thursday, October 22^nd. The DLI will follow on October 26^th.

So… it sure feels like everything is headed in a very positive direction for me. I truly feel that Jesus has wrapped his healing arms around me and he just won’t let go.

Here is a YouTube link to great song by Matt Redman called “You Never Let Go”. Enjoy.

https://www.youtube.com/watch?v=76ifTTuL4XI

Then they cried to the LORD in their trouble, and he saved them from their distress.

He sent forth his word and healed them; he rescued them from the grave.

Let them give thanks to the LORD for his unfailing love and his wonderful deeds for men.

Psalm 107:19-21

More to come…

http://mantlecell.blogspot.com/

Initial PET Scan Results Looking Good

10/2/15 – On Thursday, October I had a PET scan. I followed up with the Cancer Center on Friday, October 1^st. Although I know Dr. Goy is not available until October 13^th I really wanted to get an idea of what the results were so I called the Cancer Center and spoke to one for the nurses from the Lymphoma Team. The nurse was able to tell me that there was a great improvement from my last PET back in July but was unable to get into the specifics. She would really need Dr. Goy to interpret the results. I passed on the good news to my nurse practitioner from the Transplant Team. I heard back from her with a more details about the scans. This included the following:

Reviewed the results and I was much more impressed with what I read than what you wrote. There was RESOLUTION of FDG uptake in the mediastinum (chest) and the soft tissue mass was decreased in size… Previously in the chest the avidity had an SUV of 18.1 then 7.7 now NOT MEASURED AS ACTIVE, resolved… this is AWESOME!!!!!!!!

This sure is sounding like very good news. When I meet with Dr. Goy on October 13th I will learn more about what this all means.

I still have not had any signs of a GVHD rash. If this continues I will have a 2^nd DLI the week of October 26.

Over all it is looking like I am headed in the right direction. God is Good! God is Great!

Worship the LORD your God, and his blessing will be on your food and water. I will take away sickness from among you

Exodus 23:25

More to come…

http://mantlecell.blogspot.com/

Waiting is the Hardest Part

9/23/15 – On Tuesday, September 22^nd I had another great appointment with our nurse practitioner from the transplant team. My CMV is gone and I have been taken off of Valcyte.

Also, I have been taken off of prednisone. Now that I am off of prednisone we are in a “wait and see” mode where we are looking for signs of GVHD to appear. As soon as I see signs of it I am to take a picture of the rash and send it to our nurse practitioner. If we do not see signs of GVHS we will then move forward with a DLI in the late September/early October time frame.

Also, I am now off the heart monitor. I have a follow up with my heart doctors on October 5th.

Other than that I have a PET scan scheduled on October 1^st with a follow up with Dr. Goy on October 8^th. Understanding where I stand with my MCL is critical for the go forward plan. There is certainly more to come on this. I wish I could fast forward through the next week and a half. This is where it is best for me to be patient. I’ll just make sure I take this time to enjoy life and not worry. It’s back to having Faith, Hope and Belief in God.

Here is a link to a great song by Chris Tomlin called “On Our Side”. It stresses how God is truly on our side. Enjoy!

https://www.youtube.com/watch?v=AsomneOrQsE

What then shall we say to this? If God is for us, who can be against us?

Romans 8:31

More to come…

http://mantlecell.blogspot.com/

A Good Appointment

9/15/15 – On Thursday, September 10^th I received a call from the Transplant Team. They wanted to let me know that my last blood test came back positive for CMV. This is fairly common for people who are on prednisone. They immediately prescribed Valcyte. This is a drug that typically causes blood counts to drop.

What is CMV (cytomegalovirus infection)?

Acute cytomegalovirus (CMV) infection is a condition caused by a member of the herpesvirus family.

Most people come into contact with CMV in their lifetime. Typically only people with a weakened immune system become ill from CMV infection. Some otherwise healthy people with acute CMV infection develop a mononucleosis-like syndrome. Many people are exposed to CMV early in life but do not realize it because they have no symptoms, or they have mild symptoms that resemble the common cold. People with a compromised immune system can have a more severe form of the disease. CMV is a type of herpes virus. The virus remains in your body for the rest of your life. If your immune system becomes weakened in the future, this virus may have the chance to reactivate, causing symptoms.

On Monday, September 14^th my wife had a discussion with my nurse practitioner from the transplant team. She was checking in on how I was doing and wanted to give us a heads up that my counts will probably be low due to the Valcyte and that I most likely will need platelets. Hearing this I voiced my doubts about needing any infusions. I have been feeling so much better that last few days it was hard to believe that I would need anything. At my follow-up appointment on Tuesday, September 15^th my blood counts were good and I didn’t need platelets after all. I guess after all the years I have been going through MCL treatments I am able the read my own body.

I continue to get weaned off of the prednisone. I am down to a half a pill per day. I will need to be completely off of prednisone before I move forward with my next DLI which is targeted for the end of September. Of course if I show any signs of GVHD I will not need the DLI.

In my last post I had mentioned that I was denied PD-1. I have had friends and family who have offered to pay for it and fund raise for it. This is a very expensive drug. I did a Google search on the cost of PD-1 and it returned results that has a cost of about $150,000 per year. I really need to get a much better understanding from Dr. Goy on if this is truly something that I need. Especially before friends and family offer to help pay for it. In speaking to my nurse practitioner from transplant it is possible I will not need PD-1 if I am able to get a good GVHD response. The thought being that GVHD will kick off my immune system to start fighting my MCL.

I have a PET scan scheduled for October 1st followed by an appointment with Dr. Goy on October 8th. The PET scan will give us a status on where my MCL stands. I am hoping that I walk away from the appointment with Dr. Goy with a clear picture on what we need to do to get me to remission.

The other health item that requires follow up is my heart. I have been on a heart monitor for about a week now. I will be meeting with the cardiac doctors on October 5^th to review the results from the monitor. I am still thinking that my heart is fine and that it had more to do with the medications I am on… but this is just a guess and I am no doctor.

So I still have a few open questions. The good news is that today’s appointment was a good one and I feel like I am getting stronger every day. God is good!

 Every good gift and every perfect gift is from above, coming down from the Father of lights, with whom can be no variation, neither shadow that is cast by turning.

James 1:17

More to come…

http://mantlecell.blogspot.com/

Looking for answers

9/9/15 – I had another follow up visit with the Transplant Team on Tuesday, September 8^th. In reviewing my overall health situation there are still questions on what the plan is to get me 100% well.

Since my relapse back in March I have had 4 Chemotherapy cycles on RBAC. Although my scans show that this has been effective with greatly reducing my MCL, some disease still exists. There are currently no plans for any additional RBAC cycles. 

Also, I have had one DLI treatment back in early August. There is a plan for me to have a second DLI in the late September/early October time frame. Certainly boosting my immune system to where it fights MCL on its own is awesome. It is not clear that this will get me to the goal of remission. I guess I will learn more over the next few weeks from the Transplant and Oncology teams.

There is a new drug called PD1 that has been mentioned as something that shows great promise. Unfortunately this has been denied by insurance. I have worked with the Cancer Center to request being a hardship case with Bristol-Myers Squibb but this has been denied also. It would seem that PD1 has been effective with a number of cancers but there is not a lot of information on how it will work on MCL. Based on this it is looking like this potentially effective treatment drug will not be available to me within the near future. I don’t know, although these types of medicines come with ridiculously high costs maybe I can look into how much it costs and see if I can come up with money to pay for it on my own.

Besides my MCL, I am still working with the cardiologist team. I will be getting a heart monitor on Wednesday, September 9^th. In my opinion this is more precautionary… but it is better to be safe than sorry. There has been some thinking that the location of my MCL tumor may be the cause of my syncope/passing out issues.  If this is the case it adds to me looking to get to a remission sooner vs later. 

So as you can see there are plenty of open questions that I would love to get to the bottom to. Over the next couple of weeks I expect that I will have a much better understanding of the collaborated plan that will be in place with the medical teams of oncology, transplant and cardio.

I have a follow-up visit with transplant next week, a follow up visit with oncology the following week and I will be scheduling a follow-up with the cardiologist team after I spend some time on the heart monitor. With this I have great hopes that I start getting answers to my questions. Ultimately, I am looking to hear how I get a full remission.  

Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus

Philippians 4:6-7

More to come…

http://mantlecell.blogspot.com/

DLI Follow-up Appointment

8/31/15 – I met with Dr. Scott Rowley today to review where I am with the Stem Cell Transplant, the DLI from August 3^rd and the recent challenges I have run into. He was very thorough and answered a lot of questions.

For one thing he is thinking that my DLI was not necessarily the driver for the GVHD rash that appeared. Typically a DLI takes longer to bring on GVHD. It is very possible that the rash (and other GVHD symptoms) was coincidental. The DLI will likely start showing its signs in a week or two. In addition there is a plan for me to have a second DLI at the end of September once I am weaned off of the prednisone.

While Dr. Rowley was meeting with me he had a phone conversation with one of my cardiac doctors. The feeling of the cardiac team is that my syncope/passing out/heart issues are not due to a bad heart. They seem to be related to certain events (para influenza, GVHD, etc…). There is no doubt that I have been hit a number of new medications over the past two weeks. There is certainly a level of trial and error that comes into play being everyone seems to have a unique response.  Dr. Rowley did make it clear that GVHD is like playing with fire… and I think I can have the burns to show for it.

As far as my blood counts go, my platelets were on the low side. I have an appointment on Thursday, September 3^rd to check them again and possibly receive a platelet infusion. All my other blood counts were in pretty good shape.

Since my release from the hospital last week we have been constantly checking my heart rate and blood pressure. For the most part everything has been looking good. The one thing that is a bit of a concern is my ongoing lightheadedness. Sure, it could have to do with my fall from passing out and hitting my head. It could also be the mix of my medications. Maybe it is just me recovering from two unplanned weeks in the hospital.

I have a follow up appointment with Dr. Rowley on Tuesday, September 8^th.

So, yeah… with my chemo treatments complete you would think that everything would start moving back to normal, but with DLI now the primary means to fight my MCL things seem to be getting more complicated. There is a high level of enthusiasm with this approach from my doctors. This makes me and my family very hopeful.

Surely there is a future, and your hope will not be cut off.

Proverbs 23:18

More to come…

http://mantlecell.blogspot.com/

So what exactly is going on with me?

8/28/15 – It has certainly been a couple of interesting weeks for me... Fevers, GVHD sighting, low heart rate, etc…

My new cardiology doctors are looking to monitor my heart. I guess with a history of passing out it may be smart to see if these episodes are related in someway. 

Also, it would be great if all my doctors were on the same page but it may take some time to get there. There are just still so many questions:

Are all the mix of medications causing issues?

Is the GVHD causing the wows?

How about my MCL being fought by my immune system (brought on my GVHD)?

Do I need more research on my new heart ailments?

Do I need a pace maker to give my heart an extra boost when it is needed?

There is no doubt that I have more questions than answers.

It was great to get released from the hospital yesterday. I will be back at the cancer center on Monday, August 31^st  to meet with the transplant team to follow-up on my DLI that I received on August 3rd. While I am at cancer center it is likely I will also meet with oncology to follow-up on my recent hospital stay.

But to you who fear My Name The Sun of Righteousness shall arise With healing in His wings; And you shall go out And grow fat like stall-fed calves

Malachi 4:2

More to come…

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Quick Health Update - Back in the hospital

8/26/15 – As a follow-up to my hospital stay last week… I had an appointment at the Cancer Center on Monday, August 24^th. I am sure it wouldn't surprise you that I would encounter a challenge or two. With this visit my heart rate ran a low 30. At one point I actually had an episode where I passed out in the hospital bathroom. I had a team of doctors work on me, perform CPR, pound on my chest and get me back to consciousness. It would seem that it was most likely due to a too high dosage of the steroids I am on called prednisone that is for managing GVHD. It does appear that everything is starting to stabilize. I am hoping that I will be discharged over the next few days.

Lord my God, I called to you for help, and you healed me.

Psalm 30:2

More to come…

http://mantlecell.blogspot.com/

Crossing the line into GVHD (Graft vs Host Disease)

8/20/15 – Looking at the events of the past week for me it shows just how crazy a ride this adventure could be. With my last post I had mentioned that I have managed to avoid any hospital stays… well that has changed.

On Wednesday, August 12^th I was in the ER with fevers in the 102 range. I was given the normal work up, where they took blood cultures etc… I was given an antibiotic and after a few hours my temp was gone, my blood counts were normal and initial blood cultures were clear… so I was sent home.

I had a follow up appointment at the Cancer Center on the following day; I was given a CT scan and was told that they show GREAT improvement of my MCL. But there was nothing that caused concern of the fevers.

On the morning of Friday, August 14^th I was again running a fever and headed over to the Cancer Center. We reviewed all my tests. Being there were no signs of infection with my blood cultures,  it was decided that this was most likely something viral. If fevers did return I should take Tylenol. Any Virus will simply run its course.

Well... it is just never that easy.

On Saturday, August 15^th at around 10PM I had a fever of 104.3. Knowing full well that this is more than viral… I ended up in the ER again. The ER drew blood, put me on antibiotics, and gave me Tylenol. I was eventually admitted into the hospital by the morning of Sunday, August 16^th.

While in the hospital my fevers were treated with antibiotics, Tylenol and cooling techniques (chilling blanket and being packed in ice) but it seems that each day I still hit a fever of over 102.5.  

If you think about it… the Tylenol and cooling techniques simply mask what is really going on. In my case I was being given antibiotics that we not working… could it be that I was being treated for the wrong thing???

Each day I was visited by my doctors from Oncology, Infectious Disease and Transplant. I would get my normal checkup along with some very similar questions:

Do you have a rash?

Do you have diarrhea?

Is your mouth dry?

Are you experiencing any indigestion?

It was as if someone from above wanted to give assistance in solving this mystery, on Wednesday, August 19^th all of a sudden I had a rash on my arms and legs, I had dry mouth, I had diarrhea and I was starting to feel some indigestion.

It was now clear to my doctors that I had Graft vs Host Disease. By adding steroids to my IV regiment my fevers were soon gone. If all goes well I may be released as soon as tomorrow. That would make me very happy. I am ready to go home.

I would be completely negligent if I didn't say THANK YOU to my wife who has been by my side every second of this most recent episode. I am a very lucky man to have someone who loves me so much. I truly love my wife of almost 31 years.

.

Ask, and it will be given to you; seek, and you will find; knock, and it will be opened to you.

Matthew 7:7

More to come…

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