Busy Day

I’ve been waiting on a bone marrow aspirate/biopsy scheduled for day 29 of my treatment (tomorrow) which determines whether or not the chemotherapy has driven my Leukemia into remission. There are a few options for what path my treatment could take depending on this test but the scale and scope of each is determined be the results of this test. One of the most comforting things for me since this all began is being able to know exactly what my treatment was going to be and just trying to understand every single detail of it – I may have had little patience as a human being before being diagnosed but I certainly have none left now.

The hope is that when they take an aspirate and biopsy of my bone marrow it will show a 0-5% concentration of lymphoblasts which would classify me as in full remission and a potential candidate for stem cell transplant – or at least thats what I thought up until now. It turns out there are two other criterion which must be met before i’m classified as in full remission – basically:

  1. Platelet count above 20 Mine: 28
  2. White blood cell count above 1000 Mine: 800

Because I haven’t met the white blood cell count requirement yet there’s no reason to do the aspirate and biopsy tomorrow though the doctors seem optimistic that this will only put the procedure off until Sunday or Monday at the latest. Just more evidence that I’m going to need to find a way to be patient if I expect to survive this with any modicum of my mind intact.

Ideally when they finally do find 0% lymphoblasts present in my bone marrow I’ll be able to begin the next stage of chemotherapy called CSF (Cerebrospinal Fluid) prophylaxis. Because the cancer cells my body is producing are immature lymphoblasts, they’re capable of passing through the blood brain barrier and taking up a presence in your brain and spinal fluid. Any cancer cells that manage to make it that far wouldn’t be effected by all the IV chemotherapy I’ve been receiving -so the induction cycle i’m (hopefully) just completing now includes some chemotherapy injected intrathecally (in the spinal canal). Each time they’ve given me a spinal tap they’ve tested my CSF and found a 0% concentration of lymphoblasts though the science is fairly clear that it simply ups your odds of survival to undergo the CSF prophylaxis chemotherapy anyway.

Because Acute Lymphoblastic Leukemia mostly effects children between 2 – 5 years old with a second peak in the elderly, my case is fairly non-traditional. Because these two groups are so drastically different there are certain parts of a ‘traditional’ chemotherapy regimen that are different between them. The drug trial I’m fortunate to be involved in is designed to test an arguably very aggressive chemotherapy regimen usually given to the pediatric patients.

One part of treatment which can differ between the two peak age groups is CSF prophylaxis – Adult patients typically receive intrathecal chemotherapy along with high doses of targeted radiation directly to the brain. Some pediatric patients in the last few years have instead been opting for higher doses of intrathecal medication along with a rigorous course of IV chemotherapy over a longer period of time – which has been initially shown to be just as effective while avoiding the potential developmental side-effects of freaking brain radiation.

After working myself into almost a complete fit thinking I’d have to argue to opt for what is still considered to be a questionable alternative treatment for and adult with ALL (Because i’m such a non-typical case most of what I’ve had so far has only been done in the last few years, so it’s not a huge leap) it turns out my primary doctor agrees with me. And he’s a lot more convincing than I am.

One other cool thing which he brought up was that because this approach would be a few weeks of chemotherapy instead of just a few days of targeted radiation – I could potentially  do it as an outpatient. I might get some time home before my transplant! I’m not really sure how likely that is but the chance is cool, even just a few nights in my own bed again where I don’t have to give blood at midnight and vitals at 5:00 am. It would be a welcome respite before the (at least) few months I could be residing here on the seventh floor of the Feldberg building. the HEMONC unit is also the Allogeneic Transplant unit so I’m lucky enough to stay with the same doctors, RNs and PCTs while I’m locked up in my bubble post transplant. If I don’t go home in between they’ll just move me across the hall into a transplant room once i’m ready to begin the total body irradiation. That’s going to be an experience.

So, busy day. But things are going well and i’m scheduled to be taken off the high dose corticosteroids (Prednisone) this Sunday which I’ve been on for a month – it accounts for most of the side effects i’m currently experiencing: drug-induced diabetes, fluid retention, moon face (yeah, it’s called moon face), hyperactive appetite, abdominal pain, and mood disorders. Can’t say I’ll miss the constant finger sticks and insulin shots, diabetes was fun but you can have it back now.

– Austin

    • Jenna
    • January 30th, 2010 7:17am

    I guess they call you a patient for a reason 🙂

  1. No trackbacks yet.