Plasmablastic lymphoma

Anybody else with Plasmablastic lymphoma out there?!

 

Cheers,

Simon

  • Not sure why we’ve been loosing some messages but what I have been doing is it copy and pasting into my ‘notes app’ just incase it disappears when I send and then transfer back if necessary..

  • Hey Si,
    So glad to hear that you are doing Ok and no fevers. What is CRP?
    Please let your top 10 unpleasant procedures remain a mystery for now. Tell me strictly on a need-to-know basis! My imagination is already running riot on possible future terrors quite enough!
    So you've not had too many side effects on the lenalidomide so far?? That's good - particularly if it's effective and you are on it longer term. It seems to have been effective in the case histories I've read. So fingers crossed for us both.
    The dex hasn't been too bad this time. It's a minor detail in the scheme of things! (And as a bonus - It's given me fuller cheeks - ((desirable at 57:)) so I feel like I'm getting free botox on the NHS.)
    You asked me about my bloods. FBCs. Nothing has ever really come up much in my bloods through this whole process. I was neutropenic in round 1 and round 6 of EPOCH (no sepsis) but he really pushed up the last dose as much as he could. I also had a blood transfusion after that dose as I was anaemic but aside from that - nothing -so far touch wood.
    Ah that's interesting about the bortezomib. Have the neuropathy symptoms lasted after you finished taking the drug?
    I've found the neuropathy quite interesting from a professional perspective. I had always assumed - before I experienced it, that it would be numbness - like after an injection at the dentist -but this hasn't been my experience. For me, it has been more altered sensation. It's not noticeable when I am barefoot but once I put on trainers or thicker soled shoes, it's like my feet aren't touching the ground and it puts me off balance (which was not a great combo with chemo lightheadedness.) I'd be interested to know how you experience it.
    Tislelizumab - yes. (who makes these names up?) I wonder if you can get it in the UK?
    Thanks for the information on the thalidomide. 
    I am such a novice to all this. I really don't want to step on anyone's toes or ruffle any feathers. I am just not familiar with the professional etiquette hospital to hospital and Dr to Dr and of course don't know you well enough to navigate this territory as sensitively as I might otherwise be able to do. 
    I really appreciate you giving it consideration and potentially being open to more information sharing if it's acceptable to all parties. Given, how few of us there are, sharing brains and resources seems like a good thing in principle
    Thanks for the information you've given me so far on your understanding on the process of how to get the thalidomide which I will pass on. Any more details you could get from your consultant would be very gratefully received. 
     
    And just confirming you are still at an NHS hospital?
    My understanding is that lenalidomide almost like a cousin to thalidomide so..... 
    And I agree, I find these messages helpful on so many levels. It's so good to know there is someone a message away he 'gets it', who understands what it means physically and mentally.
     
    Well, we are off to on holiday for a few days this week (only in the UK) to 'forget our troubles' as my new treatment doesn't start until next week. 
     
    I really hope you are back home soon. 
     
    Take very good care Si,
    PS Looks like my email address has been removed. If that was you, thank you! I wouldn't know how to do that. 
     
    Sarah 
  • Hey Sally 

    Yes it’s not been a bad hospital stay to be fair!

    CRP or C-reactive protein is basically an inflammatory marker picked up from a blood test. Would be routine that they check this when you have been neutropenic in the past. Used with other markers to monitor infections, autoimmune problems and cancer amongst other things. I think it is probably the most common inflammatory marker to be used when looking at infection.

    Oh I’m sorry Sally, don’t be thinking about those future terrors too much. One can always build them up their head and they never happen or are as never as bad. Both our futures are out of our control to a certain extent so what will be will be and anything not very nice that does pop is very transient. Probably more transient than all the time worrying about it. 

    I don’t think I’ve had any immediate side effects from the Len on the short-time I have been on it ( back on it now). Although yes, it probably hasn’t been helping my white count but probably best not to compare yourself to me on that one. I think it is actually the steroids that seem to aggravate my neuropathy more than anything as it seems to intensify after a dose..

    haha I’m pleased to hear the steroid effects have actually been more positive. And you’re enjoying your free NHS Botox!!

    Thanks for saying about FBC. I’m guessing I was wandering whether your main bloods bounce back to normal when you have  been off chemo for a while? 

    My neuropathy surprisingly started with CHOP we believe. It was a late effect in 2021. Maybe 2-3 months after I stopped chemo. With extreme pain followed by numbness in the ball of my left foot and big toe. I probably had maybe four episodes of the pain on and off over a month. Each time the numbness got worse. 
    Later, probably with the bortizemab. It deteriorated a bit further and experienced some on my right foot for the first time. I have a new baseline, I’m not sure with current treatment options (they’re aren’t any) haha that could ever improve although I have found acupuncture helpful. Whilst taking the VTD-pace which included valcade/bortizemab, the neuropathy was a bit more widespread but this largerly went away as soon as I stopped treatment.  I take B12 and Pregabalin to help with some of the weird sensations I would get. Don’t really get pain as such anymore.,I’m not sure how much the pregab is helping right now. 

    I’m not sure about the etiquette of sharing information between doctors other than within a single trust. But that would be a very closed way to look at things if that were to be the case. All I know is, we don’t have the best track record with sharing tests h  information etc globally and drug companies obviously want to hold onto their new ideas and maybe not collaborate. This has made developments obviously slower than they could be and I know with something like HIV, people have been actively trying to change this way of working. Either way Sarah we can collaborate as much as we can! I think perhaps we collaborated much better with Covid, things worked much faster

    Still in an NHS hospital and it will remain this way. 
    Thal and Len are from the same family. But Thal has been around since the 50’s I think. It was withdrawn for awhile because of its link with damage to foetus’s and this gave it a bad name. I think in the 90’s it was reintroduced as a cancer drug. 
    Len is newer. Given approval in 2006 and made specifically as a cancer drug compared to Thalidomide which was discovered more as a fluke. I understand it is more potent and less toxic. The patent also came to an end a few weeks ago making it much much cheaper for the NHS. 

    Well I hope you enjoy your trip away and you can shut off from it all for a bit. I think I’m pretty safe to say I wouldn’t worry about the new regime too much as it is generally well tolerated. I’m sure what you’ve had already is far worse. But that doesn’t mean it doesn’t have a good chance at still being effective. It doesn’t always need to make you feel horrible! 

    Take care Sally :)

    Si

  • Oh and I didn’t remove your email I wouldn’t have been able to edit your post..it must have been the moderators..

  • Hey Si, 

    I love Sally. No one has used that diminutive form of Sarah on my name before!

    I Just wanted to thank you for your messages. Not only are they full of useful information but I always find them reassuring and calming. 

    I guess that as you've been living with the illness for a long time, you've got a perspective on it that as a novice I can't find yet. I am grateful to hear the tone of your mails. They are a real comfort. Thank you.

    I hope you get something from mine too.

    All the best, 

    Sally!

  • Hi Sarah,

    I’m so sorry! I knew Sally didn’t look right when I’d written it but got distracted by composing the message! But we can go with Sally if you’d like haha

    Pleased to hear I can be of some support to you at the moment. Your brain definitely changes along the journey.  My outlook and perspective on life is very different to how it was a few years ago. Which in some way is no bad thing! But it’s still tough as you know. 

    I most certainly get a lot from your messages Sarah. I really look forward to reading them- It’s really helps to know you’re not the only one!

    My CNS has agreed that I could exchange care details. . So will email over! 

    Hope your day is going okay. Very grey down here but I love the coolness!

    Simon

  • Hey Si, 
    How are you doing? I assume that by now they have been able to identify the source of your infection and give you more targeted antibiotics? I trust you got home? Hope you are feeling better? I am wondering how the lenalidomide is going? I presume it doesn't work as quickly as chemo but that it supposition on my part.
    So, since you were asking me about my blood results I asked the registrar about it. She said they were completely normal and that in fact if you looked at them, you would have no idea I had cancer. Ah, the irony! Anyhoo, it was a little bit encouraging knowing that I'll be going into this next treatment from a good place.
    As I said, they are still waiting on approval from the panel. It's another frustration isn't it, that because this cancer neither / both lymphoma and myeloma that the process is more protracted than if we were text book cases of one or the other? The waiting is very hard. Worrying that new tumours are developing. Back on the dex tomorrow at least that is something. 
    As I said in the mail, I am very sorry (and frustrated myself) that I didn't get to speak to the consultant about sharing info. But rest assured, once I get a bee in my bonnet....... My poor specialist nurse, she must dread seeing my number come up 
     
    All the very best to you as always, 
    Sarah
  • Hey Sarah

    Been a bit rough of late. Switched to IV meropenem in the end, that seemed to bring my CRP down finally. They always try tazocin first but has never really done much m for me with any infections I’ve had over the years.  Most likely infection of the lungs again. But possibly a bit of remaining prostatitis also. Whilst I was admitted and since coming home I developed some neurological symptoms. Partly  involving the eyes. Can I ask how long your visual disturbances went on for, before? I know they put it down to aura migraine but did they say possibly why? 

    Hard to tell the effect of the Len on the PBL yet. As the relapse was so minor and internal but doesn’t seem to be any evidence of it running away with itself so far! I also stopped treatment for a few days while being in hospital with the infection. So that may have interrupted things. I have just  finished the first cycle of Len. Can’t remember whether I said it’s a four week cycle with 3 weeks daily of Len. So I’m on a week break. Dex is once a week every week..

    White count was low before starting this treatment as you know. Seems to have become worse on new regime. This obviously won’t help with the infections I’ve been getting. The panel met on Wednesday to see whether I can receive the IVIG therapy alongside my chemo. But still waiting for a report. Really hoping I’ll be accepted because this should give me a boost.

    Pleased to hear your bloods are in good shape though. Certainly will help you going forward and would suggest your bone marrow hasn’t been effected too much by the chemo you’ve already had and also the lymphoma. Which is great. 

    Sorry to hear things are moving slowly. Keep pushing, you have every right. Did they give you a date when the panel will meet? Keep up with those steroids in the mean time, they do help. Feel free to use my case if you haven’t already, if necessary. It’ll help that Len is much cheaper now. Any problems let me know and I’ll see if I can get help and advice from my end


    Haha I’m sure my specialist nurse gets a bit of hard time from me. I’m forever asking questions. Sometimes unusual ones, that they wouldn’t normally get asked. I think I keep them busy! 


    Simon

  • Hey Si, 
    Sorry to hear you are not feeling so great. It must be wearing. How debilitated do you feel? It's always better to be home but that also requires one to do more. Do you have the energy to prepare food and do all the other household stuff? (When I get knocked around by side effects I find I can do stuff but it takes 2-3 times longer as I have to keep sitting down as I feel light-headed)
    Neurological issues. The visual disturbances with squiggles and absences in my field of vision were a one off and lasted a couple of hours.(They thought it was almost certainly stress.) There is also an aqueous substance in the eye which can change viscosity under the influence of certain drugs like chemo that can give you blurred vision.  
    I get very blurry vision on the last two days of dex and on the crash down afterwards. Bizarrely my distance vision improves but my reading / computer vision is awful. I almost can't read. So I now have 3 pairs of varifocals all with slightly different prescriptions - as they changed over the years - and none of them help! It usually lasts around 5 days. So sorry for any typos!!! 
    Do you mind my asking what other neurological symptoms you are getting?
    I have been testing and experimenting with the foot neuropathy. This is driven, almost certainly by disturbance to the sciatic nerve (from whatever chemical cause) which inervates the foot.  In my case, my balance is off too when I get the neuropathy so I have noticed all my calf and shin muscles get tight from me working extra hard to balance - this then makes the neuropathy worse. So I have been doing lower leg stretches and foot and toe exercises every day which seem to be helping. If you'd like more info on these or for me to give you a demo I'd be happy to.
    With regard to the efficacy of the len, did they say how long they would give it before scanning? I hope you get the IVIG to get that boost you need. Had to look that one up!
    Yup, I really lost my S*&* over the delay. I suspect it's because my consultant went on holiday. I am back next Wednesday for a bone marrow biopsy and will be at my specialist nurse every day until then. I was under the impression from the registrar that they didn't expect permission to be a problem. I think they just have long panel lists and you have to get on the list for the week! She said they were meeting on Wednesday. But it really is messing with my head. And thank you for the offer of using your case - I REALLY appreciate it. I so hope our consultants speak....
    Well I really hope things pick up for you this week. I'll be in touch to let you know if I got the len.
    Wishing you lots of energy and well-being!
    The very best,
    Sarah
  • Hey Sarah

    I wouldn’t say I’m debilitated. I haven’t actually felt too bad over the past few days. Partly due to the steroids I would imagine. But my eye sight is a constant frustration at the moment and making things harder. 
    Yes always more to do at home. But this can be good for you and good for personal autonomy. Energy not too bad but yes I generally find things take me longer than they once did!

    it is interesting what you say about your visual disturbances. Mine seem to be largely focused with the right eye although there is some blurriness in the left. It’s like an aura migraine with a blind spot in my central vision  and wavy movement. But it has become stuck for a couple of weeks  now., Eyes look fine according to ophthalmology. So there must be some aggravation of the optic nerve. Whether this is drug related or not, not sure. I’m on a long list of medications! Booked for an MRI on Sunday so will see if that sheds any light. Apparently your eyes can deteriorate temporarily after long periods in hospital. So that probably hasn’t helped either! 

    The other symptoms I had, were on a couple of occasions. The week before last. Where I couldn’t control movement of my limbs properly and my speech. Both episodes were short-lived and relieved by rest. Again not sure if this was drug related.Severe migraine can lead to these sort of symptoms but obviously reactions like this shouldn’t be overlooked.

    My neuropathy in my feet has also been bad just recently and I’m sure this does impact my balance. Find that I’ve been very up and down with it though over the past couple of years. Would welcome any exercises you are able to advise me on relating to this :) 

    The plan to start with was 3 cycles of Len then re-scan I think. I’m presuming that is still the plan! 1 down, 2 to go! IVIG was also very new to me. So don’t worry I had to look it up previously! 

    I’m sure the wait must be agonising for you. I hope you might get some  confirmation this Wednesday. I’m sure  once agreed you will start pretty sharp-ish. Hang on in there. 

    All the very best Sarah, 

    Simon