Two Trials, One Bryce

June 22, 2025 Bryce

Rosterbating

When I was in college, a show called The League debuted. It’s about a group of friends and their fantasy football league (I plan to revisit the series while recliner bound). The show coined a term “rosterbating,” which Gemini AI describes as:

“… the act of looking at one’s fantasy football team roster with great satisfaction or pleasure. This term is used within the show’s humorous glossary of terms, which highlights inside jokes and unique expressions used by the characters in their fantasy football league. Essentially, it’s a playful term used to describe the enjoyment derived from having a well-performing fantasy football roster, often leading to a sense of smugness or overconfidence.”

Let me tell you – I’ve been rosterbating over my leukemia team. So much so that it might be bordering on overconfidence. But when you ask chatGPT who the best adult leukemia doctor in the world is and THIS is its response, how can you not have GREAT SATISFACTION OR PLEASURE?

In my previous post, I mentioned Dr. Jabbour wanted to do an BMB biopsy at MD Anderson to confirm CD22 negativity, which would exclude me from the trial. Well, there’s a reason he’s numero uno in the world. We got the results yesterday and, sure enough, I’m CD22 positive – about 85% of my leukemia blasts express the marker. Meanwhile, Northwest Arkansas Pathology reported I was negative. I feel like an asshole questioning Dr. Jabbour – I straight up asked him “Do you not believe this report?” while pointing at the paper.

Back in leukemia pt 1, I had a BMB at UAMS after my first cycle. They found 0.3% of suspicious cells, but since the markers didn’t match my original biopsy performed by Northwest Arkansas Pathology, they assumed it wasn’t leukemia – just immature cells. I’m now questioning if that was actually refractory leukemia, which would’ve qualified me for blinatumomab. Insurance didn’t cover it because I wasn’t labeled refractory. I doubt I have any recourse, and I know I don’t have the energy pursue it – but I wants some justice.

The Trial

Being CD19+ and CD22+ qualifies me for the trial and helps solidify a treatment plan. I still have to complete testing to make sure I’m healthy enough to participate. I’ll admit – I’m a little concerned about my liver, Craig. If you followed along during part 1, you may recall Craig overheated a few times and was over it by the end of maintenance. Hopefully he’s up for the challenge. Even though my labs are normal, I do wonder if years of chemo (and, let’s be honest, lifestyle choices) have taken a toll.

Assuming my heart and liver check out, I’ll be one of 270 participants in the trial. So what’s the protocol?

It’s a combination of:

• Hyper-CVD (chemo)
• Blinatumomab (CD19 targeting immunotherapy)
• Inotuzumab (CD22 targeting immunotherapy)

All three are FDA-approved. Typically, they’re given sequentially — hyper-CVD to knock down disease burden, followed by recovery, then blinatumomab or inotuzumab. As I understand it, there are typically waiting/recovery periods between each therapy.

But in this trial, they’ll be administered concurrently:

• Days 1–3: chemo
• Days 4–21: blinatumomab
• Days 2 & 8: inotuzumab

Individually, each therapy can mess you up – although blina is usually well tolerated. Collectively, I imagine it’s going to wipe me. I’m nervous – but when you have the GOAT on your team, you gotta let him ball. Each cycle is 21 days, followed by a 7-day recovery, for a total of 6 cycles. I’m hoping I’ll be able to fly home during the recovery periods.

CAR-T (Endgame)

After the trial, the plan is for me to receive CAR-T therapy. Dr. Jabbour originally wanted me to do Obe-cel CAR-T, but insurance won’t cover it unless it’s done at Mayo. Obe-cel is the most recent CAR-T approved by the FDA and has a lower risk profile compared to the older CAR-T therapies. That said, the team assured me that the risk levels are pretty similar as long as you go into CAR-T with low disease burden – which I should have after getting bombed by the first trial.

They suspect insurance won’t cover any CAR-T therapy at MDA, so the plan is to enroll me in another trial where the pharmaceutical company foots the bill. I think the trial is studying CAR-T as a replacement for POMP maintenance, but I didn’t ask since free is my favorite price, and I don’t really care what they’re studying as long as I get the therapy. What is CAR-T, you ask?

Here’s my very basic understanding:
They harvest your T-cells, ship them off to a lab, tell them their mom never loved them, and train them to become heat-seeking, B-cell-destroying missiles. A month later, they get infused back into you, now fully enraged and ready to kill. The longer these killer T-cells stick around in your bloodstream and bully B-cells, the better.

The hope is that CAR-T will replace 24 months of maintenance and help me avoid a stem cell transplant altogether. If a single leukemia cell is found in the million-cell test, then transplant becomes the plan. I’ll go into detail on that if and when it’s necessary – but for now, I’m operating under the assumption that Dr. Jabbour is curing me without transplant (cue the overconfidence).

Houston Resident

For those of you who maths, time for some mathing.

• Hyper CVD + Immunotherapy trial: six, 28 day cycles
• CAR-T: two weeks inpatient and a couple weeks of follow up minimum
• Transplant: 100 days

Tentatively, if everything goes according to plan, the first trial will take about six months, and CAR-T adds another month or so. So I’m looking at seven months in Houston – assuming no transplant. If I end up needing a transplant, it’s more like a year.

It’s tough to think about being away for that long. I don’t get many more shots at this. We’re chasing a cure – and doing whatever it takes to get there.

Misc Thoughts

I’m about to join the ranks of millions of millennials living with their parents. Before leaving Houston on Friday, I signed a monthly lease for a 2bd/2ba apartment that’s half a mile from MDA’s cancer center. Theoretically, I can walk for labs and whatnot, but realistically, it’s hot and humid and we’ll be driving to appointments.

I’m spending the weekend in NWA packing a few more bags, loving on Alice and MB, and then heading back to Houston on Monday.

Yesterday was the first day I truly felt leukemia tired – like can’t move, maybe something’s wrong with me tired. I don’t know if I’ve used up all my coin-flip-you’ll-survive adrenaline, or if the long drive Friday wiped me out, or if my hemoglobin is finally dropping now that my marrow has jumped from 54% to 70% as of last Thursday’s BMB (#1 Dr. Jabbour noted, it makes no difference if my disease load is 30% or 80%). Either way, I’m tired – and I’m ready to get started.

I’m really grateful Dr. Jabbour was able to see me last week. If I wasn’t such a powerful negotiator, I’d still be waiting days just to have the initial consult.

Tuesday is packed with tests and appointments, and if I’ve got it right, I’ll be admitted for treatment that evening. I’ll likely be inpatient for about a week before being released back into the wild.

Speaking of wild…
You know what’s going to be wild? Being on high doses of steroids with access to chatGPT. It’s weirdly one of the things I’m looking forward to. There’s a sweet spot on steroids where the world feels like your oyster and now I get to pair that oyster with chatGPT, which makes anything feel possible. I don’t know what’s going to come out of it, but I’m excited to find out.