Readers of Mind Check may recall that Mantle Cell B Lymphoma is the disease that I was diagnosed as having back in late 2001 and for which I was treated first with a mixture of chemicals known by the acronym CHOP and later, that is, in October 2002, with a bone marrow transplant at Johns Hopkins Hospital. During both episodes I also received several infusions of a product called Rituxan.
Bad News, Right?
Readers of my previous posting to Mind Check will recall that I have just recently undergone a biopsy at Wake Forest University Baptist Hospital. That posting did not include the all-important pathology report of the two specimens removed from me laparoscopically because at the time I had not yet received it.
From the way I began today’s posting, you’ve concluded that the report was not what I was hoping to hear, that the pathologist saw evidence of the return of Mantle Cell B Lymphoma on the two slides that the surgeons made of what they took out of my abdominal area. Bad news, right? Yes, bad news, but I’m not ready to give up.
Problem with Procedure Repetition
As a relapsed victim of Mantle Cell B Lymphoma, I could repeat the procedures I went through in 2002—that is, the witches brew called CHOP followed by another bone marrow transplant and the extensive use of the agent called Rituxan, which is taken by infusion and which works by binding to a particular protein (the CD-20 antigen) on the surface of normal and malignant B-cells and thus triggering their elimination.
Back then, however, I was warned by an oncologist and expert on lymphoma that I should be prepared for the fact that each repetition of this blood cancer fighting combination could be expected to be less effective than the one before. How much better then to be taking a brand new agent, one that my body has not been exposed to before.
Learning Biochemistry of Cancer
Okay so that brings me back to Velcade and the reasons that I remain extremely hopeful despite a disappointing pathology report. Velcade did not exist as a viable option for fighting Mantle Cell B Lymphoma in 2002, but it’s available today. Trying to figure out how Velcade works has pushed me even deeper into trying to understand the causes of cancer and specifically blood cancer. It has pushed me to make my aging brain absorb complex biochemical concepts having to do with cell development including mistakes in cell development and cell death.
Velcade, generic name bortezomib, is a proteasome inhibitor. It is the first proteasome inhibitor to be approved for use in humans, but in reviewing some of the information on proteasome inhibitors on the Internet I see that it is not the only one and I am sure we will soon be hearing about the use of other such agents in the blood cancer battle.
Proteasome Inhibitor, What Is It?
What is a proteasome inhibitor? Sometimes when the body puts together groups of proteins to make cells it makes a mistake. What is supposed to happen is that these mistakes die, a process known as apoptosis, and are eliminated from the body. But what if they won ‘t die? What if they insist on growing? We call that process cancer.
“Proteasomes are responsible for the selective degradation of proteins when cells no longer need them,” says the Peptides International website. “Inhibiting proteasomes in cancer cells can disrupt protein regulation, which ultimately can lead to apoptosis or programmed death.” (http://www.pepnet.com/proteasome.html) This death is a good thing. We want errors in cell development to die and be eliminated, not to be perpetuated as cancer.
Helpful Publication
The best description of mantle cell lymphoma for the lay person that I have seen including causes, diagnosis and treatment options is published by the Leukemia & Lymphoma Society and is available by calling the society at 800-955-4572. (Ask for the document entitled “Mantle Cell Lymphoma” Number 4 in a series.) It is also available as a downloadable document in PDF format on the Internet. (http:// www.leukemia-lymphoma.org)
In reading this document one learns that the cancer causing error in Mantle Cell B Lymphoma has to do with a protein called cyclin D1. “MCL [Mantle Cell Lymphoma] is distinguished by over expression of cyclin D1 (a protein that stimulates cell growth) in almost all cases. The over expression of cyclin D1 is usually caused by a translocation between chromosomes 11 and 14.” Chromosomes carry the genes that convey our hereditary characteristics.
Transformation of a B Lymphocyte
Later the document tells us how this error gets turned into a full fledged disease. “Mantle cell lymphoma (MCL) is the result of a malignant transformation of a B lymphocyte in the outer edge of a lymph node follicle, called the mantle zone. The transformed B lymphocyte (lymphoma cell) grows in an uncontrolled way and the accumulated lymphoma cells form tumors in lymph nodes leading to their enlargement. The lymphoma cells can enter the lymphatic channels and the blood and spread to other lymph nodes or tissues such as the marrow, liver and gastrointestinal tract.”
Thus the war resumes for me using a new weapon called Velcade. What is at stake is something very dear to me, namely my life. I got through the first battles of this war in 2001 and 2002, and my hope is I will do at least as well in 2008. One of the things I have going for me is that I am still feeling strong and vigorous. I am no beaten warrior forcing his weakened carcass back into battle. No, I am beginning to see myself more like the biblical hero Samson once again doing battle with the Philistines.
I was reminded of the Samson image in a recent discussion of my medical situation with my friend Brooks Townes. After hearing of the latest twist in the saga of my battles with blood cancer, Brooks said, “I think of you as someone in a huge building that is about to collapse on him. Then the building does collapse. Huge pillars and huge ceiling pieces are falling all around you, but somehow nothing touches you, and you come out unscathed.” Let us hope that Brooks’s vision applies in this case as well.
To reach the author of Mind Check write Stephen.saft@gmail.com.
Copyright © 2007 by Stephen Alan Saft
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