Love, Caregiving, and Navigating Serious Illness

When Roy Bragadeste was in 12th grade, a new girl arrived at his high school in San Diego. “My first thought when I saw Diane,” recalls Bragadeste, “was, She’s the one.” Almost four decades later, the memory of that moment is just as clear in Diane’s mind. “He had a very cute smile,” she laughs, “and this adorably mischievous twinkle in his eye.”

The two dated for a year, but as often happens with first loves, they eventually broke up and went their separate ways. They each married and had children of their own, but neither forgot those idyllic teenage memories of their time together. Years later, a mutual friend reconnected the pair, and it was like no time had passed. “It was where we both were meant to be,” says Bragadeste. “We got back together, and now we’ve been married for 13 years.”

In 2015, the couple relocated to a suburb of Seattle, where Bragadeste was working at Microsoft. Their son lived nearby, the couple was raising three dogs and three cats, and life seemed perfect. Then in 2019, calamity struck. After dropping his son off for an interview, Bragadeste slipped on a patch of black ice. “I remember it was February second, because it was my birthday,” he recalls. He landed on his back and cracked three ribs.

The healing period for an injury like that is generally about six weeks, but three months later, Bragadeste was still in immense pain. “My doctor ordered a sonogram, which led to a CT scan, which led to a visit to a urologist, which led to a visit to an oncologist,” he recalls. That’s where he learned that the pain in his back was not from the cracked ribs: It was caused by a tumor pushing into his urethra, causing his kidneys to swell. He also learned he had similar tumors throughout his body. Bragadeste was diagnosed with Stage IV diffuse large B-cell lymphoma (DLBCL), a type of non-Hodgkin’s lymphoma.

I thought the doctor was wrong. Cancer was something that happened to other people.

– Roy Bragadeste

Like many patients recently diagnosed with cancer, Bragadeste’s initial reaction was disbelief. “At first, I thought the doctor was wrong. Cancer was something that happened to other people,” he remembers. “I’d felt overly tired, and sometimes I would feel like I was going to fall asleep while I was driving to work. But that just became my baseline normal, so I’d have a few extra cups of coffee. I never assumed something was wrong.”

Diane wasn’t as shocked by the diagnosis. “I know Roy so well,” she says, “and after that fall, I could tell something was wrong. I looked on the internet and read some books, and I started to get suspicious. But I’m not a doctor.” When Bragadeste received his diagnosis, Diane realized that her life was about to change as well. She vowed to devote her life to her husband’s care and comfort while he fought this disease.

“We had always thought that cancer treatment just meant chemotherapy, but it’s much more complicated than that,” says Bragadeste. “Diane is very analytical, so she researched things constantly. Before every visit with the oncologist, she worked with me to make up a list of questions to ask, and she sat in and took notes and absorbed everything the doctor said, so I didn’t have to.”

There are so many choices to make, so you have to be your own advocate. That’s what Diane did for me.

– Roy Bragadeste

“Cancer isn’t a disease with one solution, like you take a pill and it will clear up,” continues Bragadeste. “There are so many choices to make, so you have to be your own advocate. That’s what Diane did for me.”

“Cancer doesn’t just impact the physical body — it also can take a toll on one’s mental health,” Diane adds. “For a long time, Roy was in denial. He would go into the oncology waiting room, and he wouldn’t want to sit with the other patients. He saw them struggling with cancer, and he didn’t identify with that yet. I tried to connect him with resources and support groups, but he was adamantly against it, so I didn’t push. I respected his boundaries until he was ready.”

The next few years were a roller coaster. Bragadeste’s cancer would go into remission and then come back. The couple learned not to get their hopes up when they got good news, and conversely, not to go into complete despair when they got bad news. “Diane was my rock,” says Bragadeste. “Every time I felt like I was falling, I knew she would be there to pick me back up.”

There was a point where we began drifting apart. I think the constant stress just became too much for us.

– Diane Bragadeste

The emotional strain of Bragadeste’s disease began taking a toll on the couple. “I think people going through this need to know that the anxiety can really impact your relationship,” says Diane. “There was a point where we began drifting apart. I think the constant stress just became too much for us.” Instead of ignoring the issue, Diane decided to face it head-on. “I finally approached him and said, ‘This is not who we are, and I’m not going to let this trauma tear us apart. Let’s talk everything through.’”

“That’s one of Diane’s many superpowers – her straightforward approach,” says Bragadeste. “She’s the love of my life, and I’m so thankful to her for making sure we didn’t let the issues that had been building tear us apart. After that conversation, our marriage was stronger than ever.”

During one of Bragadeste’s courses of treatment, COVID struck. “I don’t even have the words to explain what a blow that was,” recalls Diane. “I was his emotional pillar, and suddenly I wasn’t able to go to the hospital with him during the most terrifying time of his life.” Unable to be together physically, the couple spoke on the phone for the three weeks he spent there. “I got so weak, there were days when I couldn’t even talk to her,” remembers Bragadeste. Diane also felt the trauma of this forced separation: “When I dropped him off at the hospital, I thought it could be the last time I ever saw him.”

During the weeks Bragadeste spent in the hospital, he slowly began to regain his strength, but his mental state continued to deteriorate from the isolation. “I needed to get out of there,” he recalls. “I was going crazy.” Trusting that her husband felt well enough to leave and committing to take over his round-the-clock care, Diane convinced Bragadeste’s care team to release him.

I never wanted him to see me as his mom – I was still his wife.

– Diane Bragadeste

For about five months, Diane was constantly by Bragadeste’s side. She tried to keep his spirits up without letting him push past his boundaries and potentially set back his recovery. “A weird line to navigate at that point was that I never wanted him to see me as his mom – I was still his wife,” says Diane. “Sometimes I needed to tell him what to do, but I never wanted to scold him or treat him like a child.”

In 2021, after years of treatment and periods of remission, Bragadeste’s care team had to have an extremely difficult talk with the couple: Roy’s cancer had returned for a third time. It seemed he was out of options, so his physician suggested that he enroll in a clinical trial evaluating an investigational treatment — a bispecific antibody designed to activate the immune system to eliminate cancer cells, but which could also affect healthy cells.

I was doing this so that physicians could gain information that might help patients in the future, even if it was too late for me.

– Roy Bragadeste

“I had accepted that I was probably going to die at that point,” says Bragadeste. “I never talked to Diane about it. But as an engineer, I understand that the only way to innovate is to try new things. Of course I had hope, but it wasn’t about that. I was doing this so that physicians could gain information that might help patients in the future, even if it was too late for me.”

While there was certainly no guarantee that this investigational treatment would be effective, Bragadeste’s physician suggested it was his best option. It was the course of action that worked best for the couple. The treatment was given over a fixed amount of time, so they felt at ease knowing they had an end date in sight. The first treatment included hospitalization, but after that, infusions were outpatient. This allowed Diane to support Bragadeste in person instead of feeling helpless at home while her husband lay in the hospital.

After Bragadeste completed the clinical trial, his results looked positive. The couple felt tentatively hopeful…but they’d been here before. According to Diane, “This whole thing has been a rollercoaster, and there are no guarantees. I always hope for the best, but I don’t know what the future holds. Every six months for the rest of his life, he has to do a PET scan to see if the cancer has returned. I’ve started to live from six months to six months — from scan to scan. But I know for certain that this is where I’m supposed to be — by my husband’s side.”

Based on the results of the clinical trial in which Bragadeste participated, the Food and Drug Administration approved the treatment, called Columvi® (glofitamab­-gxbm), in June 2023 under accelerated approval for adults with certain types of relapsed or refractory DLBCL or large B­-cell lymphoma after at least two previous rounds of cancer therapy. All medicines have side effects. In the clinical trial of Columvi, a serious side effect that was common during treatment was cytokine release syndrome (CRS), a type of inflammatory reaction throughout the body that can be severe and life-threatening. Call your healthcare provider or get emergency help right away if you develop any signs or symptoms of CRS, including fever of 100.4°F (38°C) or higher, chills or shaking, fast or irregular heartbeat, dizziness or light-headedness, trouble breathing, and shortness of breath. More important safety information can be found below this article.

Even after everything that Bragadeste has been through, he remains hopeful about whatever the future may hold, even if it means more treatment. His motivation to keep fighting is simple: to spend more time with the woman he’s loved for over 40 years. “My motto is, ‘Every day is a blessing.’ Whether there’s a blue sky, a gray sky, or a black sky, I don’t really care. I’m alive, and I have the love of my life next to me,” he says. “We are each others’ rocks. All I want to do is spend as much time as possible with her while I’m on earth. And that’s what I plan to do.”

For more information about Columvi, visit Columvi.com.

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Important Safety Information & Indication

What is COLUMVI?

COLUMVI (glofitamab-gxbm) is a prescription medicine to treat adults with certain types of diffuse large B-cell lymphoma (DLBCL) or large B-cell lymphoma (LBCL) that has come back (relapsed) or that did not respond to previous treatment (refractory), and who have received 2 or more prior treatments for their cancer.

It is not known if COLUMVI is safe and effective in children.

The conditional approval of COLUMVI is based on response rate and durability of response. There are ongoing studies to establish how well the drug works.

What is the most important information I should know about COLUMVI?

COLUMVI can cause Cytokine Release Syndrome (CRS), a serious side effect that is common during treatment with COLUMVI, and can also be serious and lead to death.

Call your healthcare provider or get emergency medical help right away if you develop any signs or symptoms of CRS, including:

• fever of 100.4°F (38°C) or higher
• chills or shaking
• fast or irregular heartbeat
• dizziness or light-headedness
• trouble breathing
• shortness of breath

Due to the risk of CRS, you will receive COLUMVI on a “step-up dosing schedule”.

• A single dose of a medicine called obinutuzumab will be given to you on the first day of your first treatment cycle (Day 1 of Cycle 1).
• You will start the COLUMVI step-up dosing schedule a week after the obinutuzumab dose. The step-up dosing schedule is when you receive smaller “step-up” doses of COLUMVI on Day 8 and Day 15 of Cycle 1. This is to help reduce your risk of CRS. You should be hospitalized during your infusion and for 24 hours after receiving the first step-up dose on Day 8. You should be hospitalized during your infusion and for 24 hours after receiving the second step-up dose on Day 15 if you experienced CRS during the first step-up dose.
• You will receive your first full dose of COLUMVI a week after the second step-up dose (this will be Day 1 of Cycle 2).
• If your dose of COLUMVI is delayed for any reason, you may need to repeat the “step-up dosing schedule”.
• If you had more than mild CRS with your previous dose of COLUMVI, you should be hospitalized during and for 24 hours after receiving your next dose of COLUMVI.
• Before each dose of COLUMVI, you will receive medicines to help reduce your risk of CRS and infusion-related reactions.
• Your healthcare provider will monitor you for CRS during treatment with COLUMVI and may treat you in a hospital if you develop signs and symptoms of CRS. Your healthcare provider may temporarily stop or completely stop your treatment with COLUMVI if you have severe side effects.

Carry the COLUMVI Patient Wallet Card with you at all times and show it to all of your healthcare providers. The COLUMVI Patient Wallet Card lists the signs and symptoms of CRS you should get emergency medical help for right away.

What are the possible side effects of COLUMVI?

COLUMVI may cause serious side effects, including:

• Cytokine Release Syndrome.
• Neurologic problems. COLUMVI can cause serious neurologic problems that may lead to death. Your healthcare provider will monitor you for neurologic problems during treatment with COLUMVI. Your healthcare provider may also refer you to a healthcare provider who specializes in neurologic problems. Tell your healthcare provider right away if you develop any signs or symptoms of neurologic problems, including:
• headache
• confusion and disorientation
• difficulty paying attention or understanding things
• trouble speaking
• sleepiness
• memory problems
• numbness, tingling, or weakness of the hands or feet
• dizziness
• shaking (tremors)
• Serious Infections. COLUMVI can cause serious infections that may lead to death. Your healthcare provider will monitor you for signs and symptoms of infection and treat you as needed. Tell your healthcare provider right away if you develop any signs of an infection, including: fever, chills, weakness, cough, shortness of breath, or sore throat.
• Growth in your tumor or worsening of tumor related problems (tumor flare). Tell your healthcare provider if you get any of these signs or symptoms of tumor flare:
• tender or swollen lymph nodes
• pain or swelling at the site of the tumor
• chest pain
• cough
• trouble breathing

The most common severe abnormal lab test results with COLUMVI include: decreased white blood cells, decreased phosphate (an electrolyte), increased uric acid levels, and decreased fibrinogen (a protein that helps with blood clotting).

Your healthcare provider may temporarily stop or completely stop treatment with COLUMVI if you develop certain side effects.

Before receiving COLUMVI, tell your healthcare provider about all of your medical conditions, including if you:

• have an infection
• have kidney problems
• are pregnant or plan to become pregnant. COLUMVI may harm your unborn baby

Females who are able to become pregnant:

• Your healthcare provider should do a pregnancy test before you start treatment with COLUMVI.
• You should use effective birth control (contraception) during treatment and for 1 month after your last dose of COLUMVI. Talk to your healthcare provider about what birth control method is right for you during this time.
• Tell your healthcare provider right away if you become pregnant or think you may be pregnant during treatment with COLUMVI.
• are breastfeeding or plan to breastfeed. COLUMVI may pass into your breast milk. Do not breastfeed during treatment and for 1 month after your last dose of COLUMVI.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

What should I avoid while receiving COLUMVI?
Do not drive, operate heavy machinery, or do other dangerous activities if you develop dizziness, confusion, shaking (tremors), sleepiness, or any other symptoms that impair consciousness until your signs and symptoms go away. These may be signs and symptoms of neurologic problems.

These are not all the possible side effects of COLUMVI. Talk to your healthcare provider for more information about the benefits and risks of COLUMVI.

You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555. Please see Important Safety Information, including Serious Side Effects, as well as the COLUMVI full Prescribing Information and Medication Guide.