Some of you who may be reading this blog today, may not find the first couple of paragraphs very interesting, as I thought I would update some of my SLL/CLL buddies out there about some of the new drugs that are currently being  researched. Later in this blog, I do have some thoughts that I hope will be of some value to all of you.

Research into new therapies for chronic lymphocytic leukemia is leading to the development of several new agents. These new agents are showing significant activity in clinical trials of patients with CLL. One drug currently being investigated for the treatment of CLL, is lenalidomide. It is currently approved in (clinical trials) for use in patients with previously treated multiple myeloma and for certain patient with myelodsplastic syndromes (MDS). In 2006 Chanan-Khan and colleagues published result of a phase 2 study of single-agent lenalidomide in patients with relapsed or refractory CLL, showing  almost 47% of patients responded to this drug. Later clinical trials have continued to show the (good) activity  of lenalidomide in CLL, but also revealed an immune response called tumor flare reaction that occurs in a large proportion of patients receiving this drug. (Signs of  tumor flare reactions include painful enlargement of the lymph nodes or spleen, rash, and bone pain). The problem is, that these reactions, under the current trial endpoint markers, (MRD-minimal residual disease) show more aggression in the disease, but has also found that those who have tumor flares, have a significantly higher complete response to this therapy than those without the tumor reaction.

Another investigational compound that is showing activity in CLL is CAL-101, it is an orally administered drug that inhibits P13K, a molecule that is central to the development of B-cell malignancies. However the same problems are being found with this new therapy. Even thought CAL-101 is showing significant activity in reducing lymph node swelling in all 32 patients tested, and many of these patients had other benefits, including resolution of  CLL related liver and spleen enlargement, lymph node enlargement, trombocytopenia and anemia. But along with these good effects, came another effect – a rapid increase in the number of circulating lymphocytes in the blood stream. This increase has been called rapid redistribution as it involves the movement of lymphocytes from the lymph nodes into the blood stream. With this effect showing itself, some have concluded that using lymphocyte count alone to define disease progression may mischaracterize the clinical benefit of CAL-101. Researchers have suggested that lymphocytosis, in the absence of other signs of disease progression, should not be counted as a disease  progression event. However more research is needed to fully understand the clinical relevance of lymphocytosis associated with this new drug.

The conclusion of those attending the new drug therapy workshop have concluded that they must take steps to ensure that these new agents are being evaluated carefully and objectively. That way, new drugs that are found to be safe and effective in rigorous clinical trials can undergo the FDA review process smoothly, and hopefully reaching patients as soon as possible.

With all of the above, one must begin to look positively at all the advances that are being made for helping we, who have SLL/CLL. I know as well as you do, that even though these new drugs may save our lives, they come to us, often very slow, and to late for some. So we must, as well as our loved ones understand how our mind thinks. Realizing that the way we think, is the way we will behave, and how our feelings will affect us, being either beneficial or damaging.

The biblical proverb, “as he thinketh in his heart, so is he. . .,” illustrates the importance of understanding the operation our mind. If we are going to understand, much less change, our behavior or feelings, we must look at the underlying thought processes of the mind. Since our thoughts determine the quality of our emotions and our feelings determine our behavior, it is important to clarify and, ultimately, change our thinking, in order to affect any lasting changes while fighting this cancer.

The concept of the mind may be best understood by divinding it into two components.The part of our minds that we are aware of at any given moment is called the conscious mind. This includes all the perceptions, thoughts, beliefs, attitudes, and reasoning that we are aware of during our waking hours. Although most of us would tend to deny that we talk to ourselves, research indicates that eighty-two percent of our brain activity involves speaking to ourselves in words and sentences known as “self-talk.” Each day we talk to ourselves about how we relate to what we see going on in the world around us. What we say to ourselves will let you, and me,  know the way you view your place in any current situation and environment.

The second component of the mind is the part which is below our conscious daily awareness. Psychologists call it the subconscious mind because it operates beneath the surface of our personal awareness, and we are normally unaware of what is going on in the subconscious mind. However, because the subconscious mind serves as a storehouse or reservoir of all our experiences, it constitutes the greater part of our minds. Just as the greater mass of the iceberg is found beneath the water level, so also is the greater mass of the mind found below our awareness level. Included in subconscious mind are all the memories from past experiences regardless of their nature and all we have learned in order to survive and cope with life. The subconscious mind is the deepest part of our being, and, therefore, may be equated with the biblical concept of the “heart.”

The Bible is invaluable for shaping the heart and mind for personal growth and development, it is not simply a rule book for successful living, or a manual for emotional health. The written word is a revelation of the grace and truth of the Living Word, Jesus. It is meant to lead us to true repentance and faith. The word “repentance” comes from a compound Greek word (metanoia) which literally means “to change your thinking.” Thus, the Bible is concerned with the renewing of the mind in order to effect lasting changes in our emotions and behavior.

In Ephesians 4:17-24, we are given a summary of the process involved in changing our natural state of worry, fear, hate, (dysfunctional life) into a supernatural healthy state; and doing it from the inside out. The Apostle Paul begins with a description of the need to change by telling us we are not to “live” (behave) like others who live (behave) “in the vanity of their minds.” This last phrase of verse 17 refers to the emptiness of dysfunctional thinking, of both the conscious mind and the subconscious mind, and is further described in verse 18. The natural state of mind is dysfunctional because of confusion (darkened understanding), dissatisfaction due to ignorance, and the inability to live in reality (hardness of heart).

Such dysfunctional thinking will naturally produce serious emotional and behavioral problems which are described in verse 19. “Being past feeling” refers to the overwhelming flood of sinful emotions which simply cast aside all good intentions in favor of doing anything to make one feel good. In other words, when hatred, self-pity, and anxiety have become so intense that we can no longer stand it, we forget everything else and naturally set a goal to feel good at any cost. When the single most important thing in our lives is to feel better, we have given ourselves over “unto lasciviousness, to work uncleanness with greediness.“ We become totally self-centered and obsessed with making ourselves feel better regardless of what the long-term consequences may be. We must remember that our family, friends, and cancer partners are going through the same emotions, feelings, fears, anxiety, self-pity, and even hatred, that we are going through. Some may hate God, for what has happened, some, other family members, and even some, themselves.

With a note of reassurance concerning our true identity in Christ, Paul goes on to describe the biblical process of becoming healthy and functional. By personal experience with Jesus Christ we can learn there is a better way to live. As the truth concerning our worth in Christ is understood and believed, we are able to shed the naturally corrupt life-style of emotional and behavioral dysfunction. The critical step is emphasized in verse 23 which reveals we must be “renewed in the spirit of your minds.” This means there must be renewed thinking (consciously and unconsciously) that will free us to take on a brand new identity (clothe yourselves with the new self) in Christ. The psalmist summarized this process when he cried out “Create in me a clean heart, O God; and renew a right spirit within me.” (Psalm 51:10).

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