Brian Koffman, MDCM, MSEd, discusses his rejection of allogeneic stem cell transplant and development of chemorefractory chronic lymphocytic leukemia (CLL) that led to his participation in an early clinical trial of ibrutinib.
PUBLISHED March 14, 2018
Brian Koffman, MDCM, MSEd: Because my disease was rather aggressive—remember that this was 10 years ago, when a lot of the treatments that are available today were not available—I elected to go for an allogeneic stem cell transplant. This is where stem cells are gathered from, in my case, an unrelated stranger who matched me in terms of the makeup of their blood cells. I received a relatively high dose of chemotherapy to suppress my own immune system so I wouldn’t reject the transplant and then the stem cells were injected into me. This took place in a hospital; I was hospitalized for about a month. But unfortunately, I ended up rejecting the transplant itself and I never engrafted, never took on, the donor’s cells. I quickly relapsed both with my CLL and my low platelet condition, my ITP [idiopathic thrombocytopenic purpura].
Having failed a bone marrow transplant and having my prognostic markers retested, I found that I now had almost all the bad prognostic markers, including a deletion of 17p, the short arm of chromosome 17, which renders CLL chemorefractory. Chemotherapy wouldn’t work for me now.
I bought some time with some immunotherapy, trying to control my disease and my low platelet condition. But about 7 years ago, there was a buzz that there were some new therapies coming. These were all in phase I trials. While there’d been disagreement among hematologists about the best approaches to manage CLL, there was tremendous excitement about these new targeted therapies that were coming aboard. At that time, they were known as CAL-101, which today is idelalisib, and PCI-32765, which is now known as ibrutinib.
I fought hard with my insurance company and decided to go leave sunny California for snowy Ohio to enter a phase I trial of PCI-32765, and I was one of the early patients involved in that trial to see how well it would work for CLL. The early data were exciting, but it was an early trial. I’ve had a very successful run. I’ve been on ibrutinib, or PCI-32765, for 69 months now with a remarkable response.
One of the big advantages of me entering the clinical trial with PCI-32765, or ibrutinib, is that it not only put my CLL into a deep remission, but it also controlled my ITP, my immune thrombocytopenic purpura. My platelet levels climbed into the normal range. So, controlling the disease also controlled the complications of the disease.