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Patient Profile for: Robert Cork



General
Mutational Status
Positive Prognostic Markers
Neutral Prognostic
Markers
Negative Prognostic
Markers
Chromosomes
Clinical Presentation
Drug Allergies

DOB: 1956
Male
Ringwood

IgVh Mutated (93%) CD38 negative (1%) Trisomy 12 Infiltrated and Diffused bone marrow

#11q
#17p
No deletions

Enlarged Spleen
2 cm nodes

Septrim
Acyclovia


General

My CLL journey started in the March of 1999 when I needed treatment on one of the left molars. My dentist recommended Route Canal treatment and a gold cap. This work needed to be conducted fairly quickly as the following Sunday I was due to fly to Canada on business. My dentist fitted me in on Tuesday lunchtime, with an appointment time of about 1-hour. The procedure was a little more complex than first thought and I was in the chair for about 2 hours. I dislike the dentist’s at the best of times, but this particular treatment gave me considerable pain resulting in me shaking for the entire procedure. Later that week, the Friday, I became unwell and it became apparent that the distress caused by the route canal treatment had resulted in Shingles on the left-hand side of my face. I was admitted to hospital for about 5 days for assessment and treatment. The shingles then progressed to Ramsey Hunt Syndrome to the left side of my face and then vertigo.

After about 16 weeks things physically reverted back to near normal apart from some enlarged lymph nodes under my jaw and facial nerve pain which disappeared after 12 months. My ENT consultant for about 9 months advised that it was nothing to concern myself about and just keep an eye on the size of the lymph nodes. How wrong this diagnosis was, because in the May of 2000, my GP decided to run a complete blood test to try to understand why I kept getting reoccurring infections. Two days later I received a phone call to return to the surgery and was advised that the hospital was recommending immunophenotyping. I went to see a local consultant hematologist who took blood samples for analysis. Physical examination noted that I had an enlarged spleen, lymph node enlargement and a wheezy chest. A chest x-ray was ordered which came back with patchy shading that he said was Pneumonia. Two days later the Doctor informed me that the reasons for the enlarged glands in my neck and the enlarged spleen were due to cancer, to be specific Chronic Lymphatic Leukaemia.

Treatment Summary

May to Nov 2002 - 6 rounds of oral Fludarbine. The reason for treatment was because of a low hemoglobin of 9.0 and failing platelets of 70. In addition, I was generally feeling unwell, a painful enlarged spleen and ongoing sinus infections. The side effects from the treatment were minimal and a partial response was achieved resulting in 18 months remission.

June 2004 - 4 infusions of Rituximab over 4 weeks. Once again reason for treatment was the declining hemoglobin, platelets and a painfully enlarged spleen. The dosage was 700mg of Rituxan infused over a long period of time, 7 hours, mainly hampered by an initial anaphylactic shock to the drug and then later in the day the chills and rigors. The Rituxan worked well for me in reducing the size of my spleen, nodes and bringing my blood counts to a more respectable level.

Jan 2005 - 4 infusions of Rituximab over 4 weeks. Once again reason for treatment was the declining hemoglobin, platelets and a painfully enlarged spleen. The dosage was 700mg of Rituxan infused over a long period of time, 7 hours, mainly hampered by an initial anaphylactic shock to the drug and then later in the day the chills and rigors. Again the Rituxan achieved the required result.

Oct 2005 to Feb 06 - 5 rounds of monthly Rituximab and Chlorambucil. The Rituximab dosages was 700mg, with Chlorambucil (6mg per day for 14 days) to try and improve the duration of the response. After the first two rounds this was increased to a 'manly' dose of 10mg. I became neutropenic after round 5 and therefore did not continue with the final round. I am pleased with the overall result, a full 24 months of remission with normal blood counts and a spleen that was not palpable, and I achieved a better response with this treatment than that of Fludarabine.

May 2008 to Jan 2009 - Fludarabine (oral 40mg), Cyclophosphamide (oral 300mg) and Rituximab (375mg/m/2) (FCR).

June 2012 to Jan 2013 - Bendamustine (IV) and Rituximab (375mg/m/2).