? for Dr. Furman

[Guest guest]

I am 11q deleted, CD38 positive and Zap 70 negative. Basal Cell

Carcinoma existed at diagnosis and treated. Recently 2 more of them

appeared plus one Squamous Cell and were treated. My ABS Lymps are

holding steady at the moment around 70K. I have no " B " symptoms and

mild lymph node involvement under my arm pits and right neck. IgG

636,

IgA 65, IgM 38. Absolute neutrophils are 4, Natural Killer Cells at

1%

and my T cells are shot:

CD3+CD4+ Normal Low 30 Normal High 60

Actual: 4%

CD3+CD8+: Normal low 10 Normal High 45

Actual: 2%

CD3+: Normal Low 60 Normal High 90

Actual: 6%

Prior Tx: One week Fludaradine at dx in 2003 and Rituxan in standard

and low dose. Last Rituxan received in December 2007. (At dx I did

not have the required Kappa or Lamba skew required for treatment of

CLL, per the NCI Guidelines.)

Here are my assumptions:

(A) I'm a " sitting duck " for a 3rd cancer, invasive SCC or

infections

in the not so long term. (Wacky B cells coupled with low T and NK

cells.)

( 11q deleted plus Squamous Cell would not be good bed fellows

with

Fludarabine. (Reference several Pub Med abstracts re both.)

Steroids

would also not be a good idea, and Campath is out because of existing

low level of T cells.

Here are my questions:

(1) What phophylactic medications would you recommend and at what

dose? My hem/onc does not know. Don't tell me to change, I already

have many times over and this is supposedly the best one in town.

I asked for Acyclovir to have on hand in case of an outbreak of

shingles. He prescribed 400 mg 2 x per day prophylactically but

admitted he didn't know whether I should wait for an outbreak to

start,

or be on it every day. I haven't started taking it. A prophylactic

antibiotic is up to me. I have amoxicillin on hand.

(2) What CLL center or specialist would be the most likely to take

the

idea of Growth Hormone seriously to boost T cells after a " to be

determined " treatment course and work with my local hem/onc to

execute

it?

The following abstracts support using it in immunodeficient

individuals. The full text of the first one references HIV and

transplant patients only.

PMID: 18292808

PMID: 18292816

(3) Would you recommend investigating a Lenalidomide or any other

specific trial?

Thanks for a response at your convenience.

Ann