Ever
since Jana was diagnosed with chronic myelogenous leukemia in early
June 2010 she has taken the great cancer drug Gleevec which produced
a dramatic drop in the number of cancerous cells in her blood. By
October 2010 the level was only .05%. The percentage continued to
decline slowly. By June 2011 the level had dropped to .001%, and
the cells have been undetectable since July 2013, putting her CML in
remission. That does not mean necessarily that there are no rogue
stem cell still making defective white blood cells, but they are too
few to be found by the test.
Jana's
side effects from Gleevec have been minimal, and she has been able to
live a normal life; however, in recent months she has had
increasingly frequent blood vessel hemorrhages in the sclera of her
eyes as shown in the picture above. (Not her eye but mine.) In the
month of February alone she had seven breaks, sometimes in both eyes
at the same time. These hemorrhages are apparently the result of a
side effect of Gleevec--a decline in platelet function but not in
platelet count. Platelets are the cells that form blood clots. If
platelet counts drop too low, we are at risk of hemorrhages or blood
loss from injury. The same is true if the platelets are not
functioning properly even when the count is normal. It appeared that
breaks in the blood vessels of the sclera that would normally have
been prevented by the platelets were no longer being blocked.
At
her scheduled visit with her oncologist at the end of February, Jana
showed him her record of the hemorrhages. He was concerned and sent
her to see an ophthalmologist to verify that nothing was wrong with
her eyes. The ophthalmologist saw nothing wrong with her eyes but
referred her to another ophthalmologist who is a specialist in the
outside of the eye. His conclusion was that her eyes are in good
condition, and that the blood vessel breaks were likely the result of
CML and/or Gleevec. Since her cell count has been undetectable, it
seems likely that the breaks were not caused by CML but by Gleevec.
Research
has shown that when CML patients stop taking Gleevec, and their cell
counts rise again, restarting Gleevec can control the disease once
again. Furthermore, there are now several other CML drugs that are
as effective as Gleevec, so Jana has decided, with her oncologist's
approval, to stop Gleevec. She will continue to record her eye
hemorrhages and have blood tests for the rogue cells, and if her CML
returns she will start Gleevec or another related drug. It will be
interesting to see if her other side effects diminish.
David
