Tuesday, September 7, 2010 - Day 9

The biology of WM starts with white blood cells – lymphocytes, or immune cells. There are two types of lymphocytes: T-cells and B-cells. Bing had a very rare T-cell lymphoma.

B-cells respond to infection by changing into a different type of cell called a plasma cell. WM is a B-cell cancer in which B-cells don’t mature properly into plasma cells. In the process, the abnormal B-cells produce large amounts of an abnormal antibody protein (immunoglobulin, or IgM).

A Swedish physician, Jan Gosta Waldenström, identified this as a cancer distinct from multiple myeloma in 1944. Statistically, it’s considered very rare. Only about 1,500 new Waldenström’s cases are diagnosed annually in the US. Just for comparison, about 250,000 new breast cancer cases are diagnosed in US women a year.

Right now, WM is considered incurable, but treatable. In looking for a cure as well as more effective treatments, researchers are honing in on what goes awry in the cell genetics. As I have been reading published research this past week, I’ve learned that researchers have identified a certain chromosonal deletion – a missing piece of DNA – that is prevalent in WM cases.

I’ve been asked a lot about “staging.” There is no standard staging system for WM. Instead, researchers and physicians look at a number of prognostic factors which they correlate into low-, intermediate-, and high-risk groups and the likelihood of surviving five years or more. I feel very fortunate that we caught this early so I have some good prognostic factors in my favor.

The abnormal B-cells have been proliferating in my bone marrow, crowding out the normal cell production and functions. This is what has been causing my platelet count to drop. I’m having a combination of a chemo targeted to blood cells and an immunotherapy, a synthetic antibody, which recognizes the lymphoma cells and “tells them to die.” So if my platelet count rises and stabilizes at a normal level, that will be the good sign that I’m responding to treatment.

It’s been sobering to compare my various lab reports with the published research articles and try to make sense of how all this applies to me. It was sobering yesterday to watch an innocuous-looking bag of clear fluid flow into a vein in my arm most of the day and think that my life expectancy depends on it. I’m sobered today by more realities of the treatments kicking in. But with the help of very knowledgeable friends, I feel I have a good handle on the short-term and longer-term considerations. For someone like me, the best comfort is being able to understand things for myself and having a game plan.