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Winning against leukemia.

"Hairy cell leukemia? What's that?" I asked.

Dr. Vince Caggiano had just given me the bad news in my room at Sacramento's Sutter Memorial Hospital, where I had been admitted with pneumonia, complicated by anemia and a dangerously low white blood cell count.

At age 62, recently retired, I didn't need this. At any age I didn't need this.

The diagnosis of my illness as hairy cell leukemia, a rare strain of leukemic cancer, had not been easy. Several tests had been performed to rule out diseases that would exhibit similar symptoms, including tuberculosis, Lyme disease, AIDS, and even brucellosis (hoof and mouth), because I had recently returned from a trip to Australia's Outback. Consulting physicians reportedly were placing bets on the root of my problem.

Finally, Dr. Caggiano and the staff pathologist, using an electron microscope, detected the hairy cell leukemia--so called because under the microscope the white blood cells look as though they are covered by small hairs.

During the next few weeks, I was to learn many medical terms. If you don't need to know them, don't bother.

Chronic leukemia, I learned, is an incurable white blood cell cancer that comes in two main varieties: lymphocytic leukemia and myelocytic leukemia. Both types attack specific, but different, white blood cells, eventually destroying the body's immune system. Hairy cell is an extremely rare strain of the lymphocytic type, so rare that many physicians never encounter the disease.

"You have options for treatment," Dr. Caggiano told me that day in July '91. "We've had some success controlling lymphocytic leukemia with interferon, a chemotherapy. That is currently the treatment of choice for you. The therapy takes about one year."

"You said I had options?"

"Yes," he continued. "For hairy cell, Scripp's Clinic has had excellent results using the drug chlorodeoxyadenosine, 2CdA for short. It's still in clinical trials, not yet approved for general use, but if you agree, I'll try to get you admitted into the program."

"What would you do if you were me?" I asked.

"I'd go," Dr. Caggiano said. "Absolutely no question. The therapy lasts one week. After that, you just need follow-up tests to verify that you stay in remission."

A few days later, on my way to San Diego to begin the treatment, I had visions of being administered the drug, strapped on a table and surrounded by researchers dressed in white gowns, observing my every reaction. What a letdown--not one guy in a white coat. Only a youthful Dr. Alan Saven, resident physician, was there to greet me and one other patient: Deanna Gragg from Aberdeen, Wash.

"This is really a good news/bad news briefing," began Dr. Saven. "The bad news is that you have cancer. The good news is you have the kind we can do something about." He then proceeded to answer our questions:

The success rate of the drug? "Excellent." Do all patients really go into remission? "Yes." How long have the 2CdA trials been running? "Three years." How many patients have been treated? "More than 300." What are the side effects? "Minimal, essentially none." How many have returned for additional treatment? "Two." Have the others all died? "No."

During a post-brief caucus with Ms. Gragg, we discussed our options.

"What do you think, Deanna?" I asked.

"Well, I've been through two interferon treatments," she said. "They were two years apart. Both were just terrible. As a matter of fact, I decided I would prefer to take my chances on a miracle, or death, before going through that again. Maybe this is my miracle."

During the next week, my "treatment," administered totally as an outpatient, was as painless as it was interesting. It began the afternoon of my arrival with a briefing by Melba Nelson, R.N., who, together with Patty Averell, R.N., administers the 2CdA clinical trial at Scripp's La Jolla Clinic. I was told that I would have a catheter inserted into my arm, and then a small, portable, battery-operated "infusion pump" would be attached to the catheter. The preprogramreed, beeper-sized pump would then inject small, micron-sized doses of the 2CdA chemical at five-minute intervals for the next seven days, regardless of whether I was awake or sleeping.

Thus enlightened, I was catheterized (a painless procedure), hooked to the belt-carried pump loaded with a week's supply of 2CdA, and sent on my way. (I was required to return each day to have a blood count taken to monitor my progress.)

The primary indicator of the drug's power during the seven days of treatment is the gradual decrease of the patient's white blood cell count (WBC). A healthy person's WBC will be in the 5,000-11,000 dl range. Patients entering the 2CdA therapy typically show WBCs much less than this: my count, for example, was 1,300. The drug performs its miracle by destroying the diseased white cells that secrete an enzyme recognizable by the 2CdA. The trick is to stop the therapy after all cancerous cells have been destroyed but before the drug kills the remaining healthy cells.

Clinical tests before my treatment had established that a final WBC of about 500 is typical (i.e., the patient's white count does not need to be lowered below that density to eradicate the disease). Although the patient does not feel anything abnormal, this low blood count results temporarily in a severely impacted immune system, leaving the patient susceptible to infections. Remember, 5,000 is considered minimal for a healthy person.

On day seven, I met with Dr. Saven.

"Your blood count looks typical for a successful treatment. The WBC is right at 500," Dr. Saven assured me. "In the next couple of days, the count should begin to rise."

The next day, the count was indeed at 600, the next was at 700, and the next at 800. "It's getting monotonous," Dr. Saven said. "Go home."

It's been 18 months since I was diagnosed with leukemia. My white cell count was back to 6,000 a few weeks after the 2CdA therapy but has remained normal. Other tests, including bone marrow biopsies, have verified that the disease is gone. Best of all, I feel great.

I still keep in touch with my heroes at Scripps who, I understand, are working on cures for many leukemias. I have this vision that one day all cancer and other equally distressing diseases will be controlled as easily as mine.

And if, heaven forbid, you should hear the "C word" from your doctor, don't despair. He may just have something in his or her black bag for you.

Editor's note: At press time, the Food and Drug Administration approved cladribine, the drug described in this article as 2CdA. It is marketed under the name Leustatin and distributed by Ortho Biotech, a Johnson & Johnson subsidiary.
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Author:Allen, Wendell
Publication:Saturday Evening Post
Article Type:Product/Service Evaluation
Date:Sep 1, 1993
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