Things That Start With B

Thursday, June 15th, 2017
Baltimore, Maryland

B-cells

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Red blood cells nourish the body; white blood cells protect it. There are different types of white blood cells, each serving a slightly different purpose. One such type is the B-cell, pictured at right. Its surface is populated with antibodies (blue) that can bind to different kinds of foreign bodies (a.k.a. antigens). Once bound, the B-cell spawns many more copies of the matching antibody. I mention all of this because my official diagnosis is diffuse large B-cell lymphoma.

Aside: Why are they called B-cells? I've wondered this for a while so I looked it up. In mammals, B-cells mature in the bone marrow; in birds, B-cells mature in the bursa of Fabricius, an obscure (at least to me) lymphoid organ. Somewhat surprisingly, it is bursa that lends the B to B-cells, not bone marrow.

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Rituximab

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Rituximab is the "R" in my chemotherapy cocktail (R-ICE). Strictly speaking, Rituximab provides immunotherapy, not chemotherapy. It leverages your own immune system to destroy malignant (as well as healthy, unfortunately) B-cells. Here's how it works. B-cells are special in that their surface is populated with both antibodies (blue in the picture from the previous section) and antigens (green). These antigens are obviously not foreign bodies but they act in the same way. (In fact, the word antigen is short for antibody generator -- anything that causes antibodies to be generated.) Rituximab is a synthetic antibody that has been engineered to bind to one of the antigens (CD20, if you are curious) that is present on most B-cells. Once the B-cells are bound, other parts of the immune system (a.k.a. natural killer cells) sweep in and destroy them (a.k.a. cell lysis). Pretty nifty, eh?

​This wonderful little antibody was created by researcher Nabil Hanna and his coworkers at IDEC Pharmaceuticals. Rituximab has proven so useful for a variety of conditions in which B-cells go awry that it is included on the World Health Organization's List of Essential Medicines, a list of the most important medications needed in a basic health system.

Aside: I realize that Rituximab doesn't start with a "B" but it does end with one.

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Brady Coyne Mysteries

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I mentioned recently that I have been reading a lot this spring as my body slowed down, preventing more active pursuits. The bulk of that reading, 25 books in all, was the Brady Coyne Mysteries by William G. Tapply. Tapply was a high school teacher for 25 years before becoming a full-time writer. He was a lifelong New Englander, avid fly fisherman and dedicated smoker, three characteristics that he shared with the protagonist in his novels, Brady Coyne. The similarities stopped there, however. Coyne is a Boston lawyer that caters to wealthy clientele that seem to experience their unfair share of murder and mayhem. Since divorces, wills and estate planning isn't exactly thrilling work, Coyne spends a good deal of time investigating those murders personally. Clearly imperfect, Coyne is sufficiently complex to keep one reading almost to the 25th book.

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By the way, what's next?

Tomorrow is the second day of this three-day chemotherapy cycle. That means another eight hours of chemotherapy (like today), along with a lumbar puncture throw in for kicks and grins. At some point, the brain fog for the cycle will settle over me and then these blog entries will either (A) stop for a while or (B) become incoherent. I'm hoping for (A).