Day +35 Philadelphia Translocation Chromosome

For fear of sounding redundant, my numbers continue to improve. My ANC is 2350 and my white count is over 3,000. I am well on my way, but still await news about my donor vs patient blood test that I had done last Thursday. Apparently it's pretty involved and the results don't come quickly.

I started on Gleevec again yesterday and although I know it's my reality it feels weird to be putting chemotherapy in my body again. The side effects have been mild and once my body adjusts I won't even know I'm on it. Gleevec is a "Smart Drug" and targets a particular abnormality that I happen to have and which caused my leukemia, (aren't I special) known as the Philadelphia Translocation Chromosome (Ph+ Chromosome) - named for the city in which it was discovered in 1960. Ninety-five percent of patients with Ph+ have or will get CML (Chronic Myeloid Leukemia).

If you remember I started out with CML (probably years ago), that eventually progressed to the blast-crises phase of ALL (Acute Lymphocytic Leukemia). The Gleevec that I started taking in March and continued taking until I went in the hospital on May 20th literally kept the blast-cell phase of ALL at bay. That and the bone marrow transplant will continue to do that. Unfortunately, I will always have the Philadelphia Chromosome (and the potential to get CML) in my body. The bone marrow transplant cannot take that away, but because Gleevec targets that particular chromosome it can be kept in remission.

Each chromosome is made up of genes which are like a set of instructions that tells the cells of the body what to do. The Ph+ Chromosome forms when two normal chromosomes break and parts from each broken chromosome switch places. This results in 2 mixed chromosomes - one of which is the Philadelphia chromosome. This change is know as translocation. The Ph chromosome is an abnormally short chromosome 22 that is one of the two chromosomes involved in a translocation (an exchange of material) with chromosome 9. This translocation takes place in a single bone marrow cell and through the process of clonal expansion (the production of many cells from this one mutant cell) it gives rise to leukemia. The discovery of the Ph chromosome was landmark and is the first consistent chromosome abnormality found in any kind of malignancy. Who knows where this discovery could lead.

Translocation makes several unusual things happen. First, a new, abnormal gene called acr-abl forms during translocation. Then, the abnormal gene makes an abnormal protein called Bcr-Abl tyrosine kinase. This abnormal protein tells the bone marrow to make more white cells than it needs to with this abnormal protein and is the underlying cause of Ph+CML. If this abnormal protein is kept under control, the number of white cells decreases, keeping the disease under control. To prevent disease reactivation it is necessary that the abnormal cells are suppressed to minimum levels at all times as some abnormal cells may still remain in my body even if they are too few to be measured -that is why I need to take Gleevec for the rest of my life.

People like me, with Philadelphia chromosome positive myelogenous leukemia (Ph+CML) will have a treatment approach which is different from that of patients who lack the abnormal chromosome. The same holds true of people with other leukemias. Fortunately, the Philadelphia chromosome cannot be passed on to descendants because it is an abnormality which occurs during cell division and is only present in the bone marrow not in the germ cells which dictate genetic inheritance.

So, that is my story up until now. I'll continue to write at least weekly. Hopefully, I won't have any "exciting" news to tell. Thanks for "listening" - it means a lot.