Sunday, June 13, 2010

Sunday, June 13, 2010

Dr. Martin was just here and gave us a TON of information. Here's more details than you possibly need, but I typed furiously as he spoke, so I think I got it all.

Diagnosis: ALL (Acute Lymphocytic Leukemia)

The treatments are sporadic, so I'll explain. There are 3 different schedules (I, II, III below) consisting of a total of 7 months (A,B,C are each a month long).

I     A, B, C
II    A, B, C
III           C

A and B cycles: 3 1/2 weeks in hospital
C cycles: 4 days in 10 days out, 4 days in 10 days out.

We are currently in schedule I A.

He will be in the hospital for a total of about 4 1/2 out of 7 months. All here at UCSF.

The actual treatment/drugs are as follows (this is very confusing and I'm sure I spelled them all wrong, so bear with me with the scattered thoughts)

Initial Therapy: 3 medicines on days 1, 2, 3, 4, 8, 15, 22
Dexzamethysone, (steroid) starts today for the next 4 days which should help with the bone pain and reduce his need for pain meds (side effects: water weight, abnormal energy, lack of sleep, with a crash on 5th day where he'll feel tired
Vinchristine (via IV) weekly for 4 weeks (side effects: tingling in fingers/toes and constipation)
Dinarubicin knocks off cells that grow fast and starts tomorrow for 3 days after echocardiogram (side effects: can effect the way heart pumps)

Those will put him into "remission" by the end of his stay this month. Today is day 1, he'll be done by day 28, and back here for the next round by day 35.

2 weeks from tomorrow another bone marrow biopsy will be done to see if the cancer cleared out. They don't want to see ANY cancer with that biopsy.

He will be on a maintenance therapy after the 7 months of treatment which will be a daily regimen of pills which will end at about the 2 1/2 year mark.

ALL tends to hide in the spinal fluid / brain stem so he will need lumbar punctures six times over the next 3 months and chemo pumped directly into the spinal fluid. First spinal will be this week.

This plan can change depending on the results and how he handles chemo. There will also be a chromosome test to tell if he has the Philadelphia chromosome (50% chance) which will change things and will need a possible bone marrow transplant if he has it. The best donors are his siblings who have the same mother/father. If he does in fact need a bone marrow transplant, it is very uneventful. A donor gives blood and it goes into a drip line in his PICC line. It's that easy. No surgeries, no hospitalization. A transplant comes with it's own side effects/issues which I'll explain if it comes down to it.

Other issues are his blood counts. There are 4 different levels they look for (WBC, ANC, RBC, PLT) and when certain numbers drop, they have to either give him blood transfusions (RBC) or platelets (PLT). When his ANC numbers drop he goes into a state called "neutropenic" which means he has little to no white cells left (this will happen in the first couple of days after starting chemo). This is when things get a little more serious as he is very susceptible to infection. He will no longer be able to eat any outside foods and anyone who is sick must stay away. They can give him shots of Neupagen which can help booster his white cell count to help fight off infection.

I think that's all the information that I have at this time. Any questions??? Hit me while I'm hot and I can remember!

Jen

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