As I’m visiting different Kaiser-Permanente facilities in DC and northern Virginia, we noticed the prominent signage and got stopped by numerous security guards and medical staff to inquire about my N95 mask. With each, I explain that I am a cancer patient, that I am immunocompromised, and I show my medical ID bracelet or Kaiser-Permanente member ID card if asked.
When we met with my oncologist today, she wore her mask and kept a good 6-foot distance from me as we spoke. She voiced her concerns that I am at extreme risk for Coronavirus between my decreased neutrophils, lymphocytes, red blood cells, white blood cells, and platelets.
With my weekly Rituxan therapy, I was running a greater risk of lymphopenia since:
Rituxan (rituximab) can induce prolonged B lymphopenia and expose patient to infectious complications. It has been well-documented in most of the oncologic studies. All CD20+ cells are affected by monoclonal antibody rituximab, or other anti-CD20 monoclonal antibodies, as well-obinutuzumab, ofatumumab, veltuzumab. If you look at the basic blood cell count you could see lymphopenia in most of patients treated with rituximab. This lymphopenia is deep and long-lasting. There are some publications that pointed to higher risk for lymphoma relapse if lymphopenia persist longer than 6 months after rituximab treatment.
Both Johns Hopkins and Kaiser-Permanente agree that I have an unusual case of aggressive mantle cell lymphoma for which they have no data. Given that I am on my third remission, that I had two previous relapses of aggressive lymphomas after two to three months, they agreed that I should have “maintenance chemotherapy” of Rituxan monthly for the next three years. They will be monitoring me closely with telemedicine visits, frequent PET/CT scans, and weekly blood draws.
And so I continue to take it day-by-day, week-by-week, and month-by-month. I’ll no longer get my hopes too high or celebrate when a PET scan is clear or a week’s bloodwork is good, but I’ll be thankful and grateful for both the good news and my time. If we can go for several months or a year without a relapse, then truly can I relax a it more, breathe easier, and truly give thanks or celebrate my time free from Stage 4 Mantle Cell Lymphoma.