Case Studies

Catch 22 — The Transplant Minefield

Balancing the Chance of a Real Cure Against Transplant Mortality Risk

Expert Opinions Diverge on Timing

Many CLL patients with adverse prognostic indicators know that sooner or later they will have to face the prospect of a stem cell transplant. Current research shows improving results from mini-allo transplants for CLL patients, especially if they have clean remissions and are otherwise in good health going into the transplants. While this might argue for early, elective transplants for some patients the mortality risks are still significant and there is as yet no consensus among transplant experts on timing and exhaustion of other therapy options. To understand the issues involved, please read our case study of an anonymous patient volunteer in Catch 22 — The Transplant Minefield. (7/4/07)

Therapy Choices

How Much Time Do You Think You Have?

Jenny Tells the Forest Story

Forest Bump is the pen name of a CLL patient who volunteered to share with our readers his experience in the FCR Lite clinical trial. You can read the first installment of this case study in Forest Bump. As it sometimes happens with CLL, what followed next was not something he or his wife, Jenny, or indeed any of his doctors, anticipated. Forest suffered complications brought on by his CLL and died in early March. Jenny bravely picks up the tale here, in the conclusion of the Forest Bump saga titled Jenny Tells the Forest Story. Easy answers are hard to come by but the story may provide you with some serious food for thought. (4/23/07)

Poor Prognostics

The Road to a Stem Cell Transplant

Greg's Story: A Cautionary Tale

Greg's Story is a case study based on the notes of an anonymous patient. It is a cautionary tale about the dangers inherent in a relapse in the face of poor prognostics. Delaying the decision to seek a mini-allo, the only known cure at this point for poor prognostic disease, can result in that choice being removed suddenly. You will learn why Greg feels poor prognosis CLL should be taken very seriously, why prognostic indicators do matter and why a decision on pursuing a mini-allo should be made early in the process. (3/30/07)

FCR Lite Clinical Trial

The Road Turns Less Bumpy for Our Hero

Introducing Forest Bump

Our intrepid volunteer, thinly disguised as "Forest Bump", reports on his experience as a participant in the "FCR Lite" clinical trial being conducted at the University of Pittsburgh Cancer Institute. Forest, you will discover, has a unique personality and view of life. We hope his tale, Forest Bump, will be useful to those interested in a "lighter" version of the widely used FCR protocol. (2/24/06)

Continuing Medical Education

A Few Short Years Can Change Some Important Things

Death by Conventional Wisdom

The conventional wisdom of a few years ago can prove dangerous when doctors treat patients by outdated rules of thumb. In our critique of this case study reported by a professional journal in 1999, we identify the necessity for both physicians and patients to understand and employ modern risk-based strategies in dealing with this varied disease. Read Death by Conventional Wisdom to understand why staying on top of new developments is critical for your doctor — and even more so for you. (8/17/05)

PCR Therapy

A Patient's Experience with the Pentostatin-Cytoxan-Rituxan Clinical Trial at Ohio State

Katie's Story

Another committed volunteer, Katie, does her bit for patient education by reporting on her experience with the PCR protocol in the phase 2 clinical trial jointly run by Mayo Clinic and Ohio State University. Katie, with a family history of CLL, is happy that she made her contribution to CLL research by volunteering for this clinical trial. To read about it, click here: Katie's Story. (11/18/04)

CTL Therapy

A Volunteer Records Her Experience with the Xcyte Therapies Protocol

Arabella Gets Xcyted

Another intrepid volunteer steps forward to share her experiences while undergoing yet another cutting-edge therapy: the Xcyte Therapies, Inc. protocol, conducted at an anonymous Consortium Cancer Center. In her report, Arabella (not her real name, we confess) sets the stage and tells the tale of her experiences as a participant in this clinical trial: Arabella Gets Xcyted. (7/28/04)

Maintaining and Managing a Remission

The Dangers of Overmedication

Updates on the Case of the RHK

Harvey, our Round Headed Kid, is experiencing the benefits of a deep remission after going through the "RHK protocol" three months ago. He is on an aggressive regimen of medication, supplements and exercise, a program that he and Serena negotiated with "Doc" to keep his remission going. However, nothing is simple for our hero. In this update Harvey and Serena find out from a blood test that it pays to be vigilant - you will learn about the dangers of drug interaction and overmedication in the Remission Management for the Round-headed Kid, the next couple of snapshots in our continuing case study. If you wish, you can start with the first instalment of this serial case study, the Difficult Case of the Round-headed Kid. (6/24/04)

Diagnostic Tools

John and Jane Make a Point or Two

ZAP-70: Why Should You Care?

We play out a few hypothetical scenarios that demonstrate it pays to know your prognostics. We are equally in danger of doing too much as too little, and more ominously, doing the wrong thing. Read ZAP-70: Why Should You Care? to learn why you should. (4/4/03)

Therapy Choices

Case Study on How Choices Are Made

You Are the Doctor

This discussion of an actual patient history published by the Moffit Cancer Center provides an illustration of some key issues. This is the kind of document that really helps us in understanding how therapy options are identified and how oncologists make their decisions with reference to individual patients. Read You Are the Doctor to see what happens behind the scenes. (3/16/03)