Yesterday I started a new clinical trial at UCSD for people that have relapsed on Ibrutinib. I had been a part of the RESONATE trial and have been on Ibrutinib for 4 1/2 years. Early this year began a trend of increasing ALC and enlarging lymph nodes. A next Gen Sequencing test showed a mutation in the C481S gene, confirming that eventually Ibrutinib alone will become ineffective. This trial is trying to determine if by adding Venetoclax, it will block additional pathways and may event delete the C481S mutation making Ibrutinib effective once again. In untreated patients the trials have shown that there is synergy in combining Ibrutinib + Venetoclax. So the hope is that even in heavily pre treated, complex karyotype (I am both of these) that there still will be a response. The main problem with this trial for those of us with Medicare Part D, is that I am responsible for the Venetoclax co-pay, which will be about $10,000 for this year. The Ibrutinib will be paid for in the trial. I know this sounds crazy for a trial, but the main reason is that they are going to test a non-standard dosage of Ibrutinib, while the Venetoclax dose is the standard 400mg dose. Hence, Venetoclax is considered 'standard of care' for relapsed with a 17p deletion. No issues so far, but I am only on day 2. But I have never been so hydrated. I am considered 'low risk', so doing the standard 5 week ramp up of the Venetoclax to get to 400 mg. More to come.