Patgient Dies after Using Allopurinol with Treanda

This is a surprise to me; hope word gets out quickly!

http://www.bizjournals.com/philadelphia/stories/2009/04/27/daily20.html

Tuesday, April 28, 2009, 2:34pm EDT

Following patient death, Cephalon warns of using Treanda with allopurinol

Philadelphia Business Journal - by John George Staff Writer

Cephalon is updating the prescribing information for its cancer treatment drug Treanda to include a warning about the use of the drug with allopurinol, according to documents filed with the Securities and Exchange Commission on Tuesday.

According to the filing, the Frazer, Pa., biopharmaceutical company identified two cases of Stevens Johnson syndrome in patients treated with Treanda and allopurinol — one of which was fatal.

Allopurinol is used to decrease levels of uric acid in certain cancer patients.

Stevens Johnson syndrome is a rare, and potentially deadly, skin disease.

Treanda was approved last year by the Food and Drug Administration as a treatment for chronic lymphocytic leukemia and non-Hodgkin's lymphoma.

“Although the relationship between Treanda and Stevens Johnson Syndrome cannot be determined, there may be an increased risk of severe skin toxicity when Treanda and allopurinol are administered concomitantly,” Cephalon (NASDAQ: CEPH) stated in its filing, adding that allopurinal is known to cause the syndrome.

The updated prescribing information is expected to be implemented in early May, the company said.

Mexican Swine Flu Migrating, but seems mild

The pandemic is 'past control' according to the WHO, but so far, it is proving to be remarkably mild in the developed world. Mexico has seen over 100 dead. To keep that in perspective, tens of thousands Americans die each year on average from the garden variety of the flu.

As a barometer, Google News has bumped the story from the headlines, from the sidebar, to related stories below the fold, so to speak.

I think everyone is mystified, but thankful, that the flu so far is very, very mild, except in the country in which it started.

Updates on Mexican Flu

The potential for a pandemic continues, though governments have finally taken action. In Mexico, the government has taken positive steps to halt the spread of the disease, though actions come after the disease has been found in several other countries, particularly the United States.

Over 100 people are now dead in Mexico, the apparent epicenter of the flu. No one has reportedly died in the United States, and many of the victims appear to be in their teenage years. The disease has been characterized as 'mild' in the US, with all victims apparently on the mend, or at least not getting seriously ill. Whether that continues remains to be seen. It is possible that the Mexican flu has gotten a foothold in that country, and authorities have been slow to respond, while in the US with its superb medical system, doctors have been treating appropriately, and early. The general better health of Americans may also play a part, in my opinion. The disease has seemingly been appearing (so far) only in people who have recently returned from Mexico. These people are wealthy enough to travel, and probably in good health, since sick people generally don't wish to travel.

Chronically ill people in the United States need to be hypervigilant. This means avoiding crowds, staying away from coughing and/or sneezing people, and washing their hands frequently. I personally would suggest considering not going to work tomorrow and in the next few days or weeks, especially if the Mexican flu has been detected in your city. I also suggest avoiding or limiting contact with children or teenagers in school, since that is a perfect environment in which to foster the spread of this serious disease.

I still work, and live in Sacramento California where a possible case was just discovered in a student who recently came back from a trip to Mexico. His school has been closed as a precaution. I may still go into work, since I have an office with a door that can close. I purchased a wall-mounted germ sterilizer, which I hope will help kill any viruses that sneak in under the door. If the flu seems to be spreading in Sacramento, then I will stay home. I also will discuss with my supervisor my need for precaution, and explore the possibility of working from home, something my employer has refused vehemently to date. I do have plenty of sick leave and vacation, which I will not hesitate to use.

As the old television program advised, "People, let's be safe out there".

Sobbering Events - The Mexican Flu Gains a Foothold

I'm watching in morbid fascination as the potential of a global pandemic, with resulting illness and death, spreads from the Third World to the First across a porous border.

As I write this, Mexican Flu cases have appeared in California, Texas, Kansas, and New York. So far, no deaths linked to the flu have been reported. It will likely not be long before we learn of the first death of an American to the Mexican Flu.

For CLL patients, and others with serious, life-threatening conditions, this comes as frightening news. The Mexican Flu is eerily similar to the Spanish Flu pandemic of 1918, killing healthy young adults (20-40) rather than the usual children and elderly populations.

The specter of bioterrorism has already been raised, but it doesn't take a terrorist attack to bring the potential of such a calamity to our world, already battered by a severe economic downturn. You'd think someone had it in for us. Maybe they do.

The misery of the Great Depression was worsened by a long drought resulting in the Dust Bowl. We now have a potential pandemic in the midst of another serious money panic. Do these things go together.

The President of Mexico has now exercised emergency powers. This comes as Mexico failed to respond with the first inklings that something out of the ordinary was going on. Only when the First World (The US and Canada) were able to analyze the genetics of the victims in Mexico did everyone realize there was a flu that seems to meet all of the requirements of a pandemic: human-to-human transmission, humans can become infected with it, and the populace has no immunity to it. In my opinion, these conditions have already been met.

I will be interested to see what happens to the stock markets of the world on Monday. If the news continues to get worse, a nascent recovery will die a quick and early death.

The government claims they are ready to stem a pandemic quickly. We'll see how this pans out.

Meanwhile, keep doing what you should have been doing all along; wash your hands frequently, avoid crowds, avoid sick people, cover your nose and mouth while sneezing or coughing.

A bit more on fasting before chemo

I neglected to put a citation in on the post about fasting before chemo. I can't seem to find the reference at the Proceedings of the National Academy of Sciences website, though.

Here's a news blurb on the subject if you want to read a bit more on it. The technique may protect healthy cells more than kill cancerous ones.

http://health.usnews.com/usnews/health/healthday/080401/fasting-before-chemo-protects-healthy-cells.htm

The article quotes a researcher at the University of California, San Diego who cautions that not enough is known in the human population to predict if this technique would be effective. There are some cancers, he notes, that some cancers have already altered metabolic functions in normal tissue already, and fasting might not add anything to the current treatment regime.

Interesting to note, though. I wonder if any CLL researchers have an opinion on this now, or if they will take refuge in the all-purpose answer, "it's too soon to know yet."

For Americans Only

It's a few hours before April 15, a date heavy with meaning for Americans. It's the day federal and state income taxes are due. Despite suffering from cancer, or going through chemotherapy, the IRS wants its money, and it wants it NOW!

I have somewhat of a complicated return, so I've in my third week of working to get this monster done. It's nip and tuck whether I can finish on time.

On the other hand, I've never failed to get at least the federal return in on time. I hope I stay healthy enough for one more day...

Should you fast before chemo?

There is evidence that you might be doing yourself a favor it you do.

Me? I'm so addicted to food that when I fast, all I think about is food. I could fast one day. Two days? I've had to do it before a colonoscopy that I had late in the day one time. All I could think about was food.

I think it would be worth a try!

I'm through with FCR, so this advice comes a bit late for me.

When it's your life, this might be something to at least run by your onc doc.

Feeding the Beast

If I dropped dead tomorrow, my cancer would be cured. Sounds kind of a stupid thing to say, but let's consider it a bit.

Once my heart stops beating, the CLL cells are going to soon be feeling the pinch. Nutrients are going to stop coming along, the blood flow bringing oxygen and taking away carbon dioxide simply won't be there. The protective vitamins such as vitamin C the cancer cells use to fend off death are going to be used up, and no longer serving a purpose. The CLL cells begin to die.

Obviously, this is a drastic (but 100% effective) CLL cure. Can we use this impractical information to our advantage? I think so.

We can perhaps slow the growth of the CLL clone by denying them the stuff of life. With our limited knowledge (we don't know, for example, what drives the CLL cells to merrily proliferate until it kills us, and it), we can't cure CLL by 'gentle means', but perhaps we can slow its growth.

And since CLL is an indolent (slow growing) cancer, with a potential lifespan of more than a few years, slowing the growth may mean months or even years more of good quality of life. This means, perhaps, more of us will be around when truly effective treatments are finally available.

I'm going to discuss one of those vital constituents as I see them, that the CLL cells require to madly and indiscriminately split and split and split. That's cholesterol.

Several papers have been published that point out that the standard cholesterol tests are not a valid indication of the cardiovascular health of the CLL patient (http://tinyurl.com/dha4hc). It seems that both high-density lipoprotein, HDL (the 'good' cholesterol) and low-density lipoprotein (LDL, the 'bad' cholesterol) is decreased in the CLL patient as the disease progresses.

Consider this paper in PubMed: http://tinyurl.com/dmegog. It asserts that cholesterol levels are reduced in progressive blood cancers including CLL, and that cholesterol levels rise when there is a response to chemotherpeutic intervention.

It's tempting, then, to conclude that the rapidly proliferating CLL cells 'sop up' large amounts of cholesterol to support their indiscriminate breeding. It may follow, then, that limiting the amount of cholesterol available for these cells to grow might slow the proliferation down.

I'm not aware of any studies that have tested this idea in CLL, but the idea has been floating around for some time. It's been known for years that high cholesterol is a risk factor in the development of cancers, but as far as lowering the levels as a means of slowing cancer's growth, much less is known.

There is one interesting paper, though, that concludes that the use of one type of statin drug (which is designed to reduce cholesterol levels), simvastatin, seemed to cause a slowing of the growth of the clone (http://tinyurl.com/cbzaac). Ironically, it was noted in the paper that some 40% of this very small sample of patients, went on to require treatment the following year. It is unclear from the abstract whether these four patients were the same ones who had noticable effects on their CLL clones. The apparent conclusion these researchers reached was that the use of statins may actually increase the need for treatment. The very small sample size makes reaching that conclusion difficult.

It seems reasonable to consider moderating the amount of cholesterol coming through the diet. The body is perfectly capable of manufacturing enough of the substance to meet the needs of the brain and body without necessarily consuming it.

This means going on a low cholesterol diet, exactly the same as one would adopt if one was concerned about heart disease. Low saturated fats, avoiding all sources of cholesterol in the diet, lean proteins, use of good fats in lieu of 'bad' fats, and so on. There are plenty of these diets and advice elsewhere on the web.

Another way of lowering cholesterol is to eat a higher-fiber diet. This includes both soluble and insoluble fiber. By increasing the bulk of the stool, the amount of bile acids excreated is increased. And since we know that these substances contain cholesterol, this effort can decrease cholesterol further.

We can't go too far, because a certain amount of cholesterol is necessary in the body, so I'd talk it over with your doc, and track your over-all cholesterol level.

Maybe it would have a slight, but real, effect.

Waiting for BMB Results

I had another bone marrow biopsy last Wednesday, March 25. I can't count how many I've had, perhaps nine? For some reason, they've gotten increasingly painful. When I had one at MD Anderson, they told me I needed some sort of pain-killer, so that's what I asked for this time at UC San Diego. I got a prescription the day before from Dr. Kipps. It worked pretty well, I had percocet. They told me to take it when I got to the clinic, but I worked out that the maximum pain-killing aspect of the drug was at about one hour. That will be useful information if I ever have a BMB again.

I don't have results. Dr. Kipps has held off with any thoughts of other treatment until we get the results. I would have thought I would have heard about the results by now; perhaps he just doesn't want to give bad news?

I've had somewhat of a hard time dealing with my failure on FCR. My blood numbers are OK, a little low, but OK. However, the percentage of the white blood count that are lymphocytes are going up, and the percentage that are neutrophils are going down, obviously a poor sign.

He mentioned getting a Neulasta shot on Wednesday, but I forgot about it and the physician's assistant also apparently forgot about it. I have a call into Sheila Hoff, but have not heard back from her. I would I guess (now) get the shot in Sacramento, since it would be ludicrous to fly back down there for a shot.

I wish I had remembered, not that they shouldn't have arranged it themselves. Failure all around.