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Prior to the COVID-19 pandemic and the advent of ride-sharing services such as Uber and Lyft, it wasn’t unusual for 10,000 yellow taxis to dot the busy streets of New York City at any moment. About half that many roam those roads these days, and Brooklyn native Joseph* finds that hard to believe.
“I drove a cab in New York City for 32 years, from 1954 to 1986, and back then they were about the only cars you saw on the street, especially in Manhattan,” Joseph says. “That just goes to show you nothing stays the same forever.”
Joseph, who started a small limousine service with his brother-in-law in 1980, once thought he’d live forever in the Big Apple, but he sold the business a few years ago and moved to Florida.
About a year ago, shortly after celebrating his 88th birthday, Joseph received some distressing news.
“I had just visited my primary care doctor for my annual checkup, and about two days after the checkup, my doctor called me and said he had some concerns about my bloodwork,” Joseph explains. “He said something about my platelets being low.”
Platelets are the cells that circulate throughout the blood and bind together to form a clot whenever someone suffers a cut or scrape. A normal platelet count ranges between 150,000 and 450,000 per microliter of blood. Joseph’s count was 83,000.
A platelet count that low could be the result of certain medications, liver dysfunction or even cancer such as leukemia or lymphoma.
Concern over the latter possibility prompted the doctor to recommend that Joseph visit Florida Cancer Specialists & Research Institute. It was there that Mamta T. Choksi, MD, began her care by ordering a flow cytometry test.
Virtually Symptom Free
Designed to diagnose and classify blood cell cancers, the flow cytometry test confirmed the primary care physician’s concerns that Joseph, despite showing virtually no symptoms, was suffering from chronic lymphocytic leukemia, or CLL.
“The symptoms we usually see with CLL are things like fever, chills, night sweats, a feeling of unwellness and unexplained weight loss,” Dr. Choksi educates. “Out of those five, Joseph only had an unexplained weight loss of about 10 pounds.
“This is a man who has been relatively healthy for his age, a man who never smoked and doesn’t drink. This confirmed the diagnosis, so the next thing we did was order a CT scan of his chest, abdomen and pelvis to see the extent of the disease.”
The CT scan would reveal the condition of Joseph’s lymph nodes. In people with CLL, the lymph nodes can be enlarged. So, too, can the spleen. In Joseph’s case, the CT scan showed slightly enlarged lymph nodes. That further confirmed the diagnosis and helped lay the foundation for a treatment plan.
Dr. Choksi notes that there was never any hesitation in creating a treatment protocol for an octogenarian.
“Some people may wonder why we would treat someone at the age of 88 with this condition, but again, this is a relatively healthy 88-year-old man,” Dr. Choksi reasons. “There was no good reason not to treat him.
“The only concern we had in putting together a treatment plan was that he had a history of heart disease. Because of that, we needed to avoid certain medications, but we were still able to put together an effective treatment plan for him.”
Dr. Choksi called for Joseph to receive a combination of two drugs: GAZYVA® (obinutuzumab) and VENCLEXTA® (venetoclax), which earned FDA approval for use in patients such as Joseph in 2019.
GAZYVA was administered intravenously once a week for six months. VENCLEXTA is a pill that can be administered in a variety of doses that increase incrementally in cycles. In Joseph’s case, he began with a 20-milligram dose.
“During Cycle 1, which is the first four weeks, you go from 20 milligrams to 100 milligrams,” Dr. Choksi explains. “Then for Cycle 2, you start with a 200-milligram pill, and then in two weeks from Cycle 2 onward, you can go up to 400 milligrams.
“That is the recommended dose, and (Joseph) tolerated the treatment well in terms of how he felt. But his platelet counts fell even further, to 20,000, which is something this medication can do until it starts working in the bone marrow and the patient starts to get better.”
You Can Do It
The additional drop in platelet count, which could have led to a risk of increased bleeding, forced Dr. Choksi to scale back Joseph’s treatment by suspending the use of VENCLEXTA for three weeks, then limiting his dosage to 100 milligrams after that.
That allowed Joseph’s platelet count to rise again, and while it added another three months of treatment using VENCLEXTA to his regimen, the results were just what he and Dr. Choksi were hoping for.
“Even with the lower dose of VENCLEXTA, he responded quite well and continues to have a good quality of life,” Dr. Choksi reports. “And that is our goal because we are not going to cure this condition.
“The best we can do is keep it under control to the point where the patient still enjoys their life and we increase their durability or survival rate. And that’s why age is not a factor in considering treatment for any kind of cancer, including blood cancer or leukemia.
“With the treatments, we have now, the response rate is higher and side effects are lower, so patients of any age can maintain a good quality of life. That’s what we were seeking in treating Joseph and it’s working well for him.
“In fact, he should be an inspiration to others out there. Learning that you have cancer or leukemia is a scary thing, but we can help you. And if this 88-year-old man can live a good life, so can you.”
Joseph is living a good life and says he has Dr. Choksi and the staff at Florida Cancer Specialists & Research Institute to thank for that.
“I really could not be more pleased with how I’ve been treated,” Joseph says. “I didn’t feel bad to begin with, and now I feel just as good as I did before. I also feel fortunate that I was treated so well by Dr. Choksi and her staff. They’re great people.”
© iFoundMyDoctor.com article by Roy Cummings.
* Patient’s name changed at his request
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