October 31, 2008

Stages of Treatment

Okay this is mostly for medical minded people like myself.  But it will give everyone an idea of what Paige's treatment entails.  She has finished the induction stage which went from October 1 - November 2nd.  I will lay out the following stages and what treatments she'll endure:

Consolidation Nov 3 - 30th
  • IV chemo (vincristine) once on the 3rd
  • LP every week for 3 weeks (the 3rd, 10th, 17th),(they inject chemo, methotrexate, into her spinal fluid with every LP)
  • oral chemo every day (mercaptopurine)
Interim Maintenance Dec 1 - Jan 25
  • IV chemo every 10 days (vincristine and methotrexate IV)
  • One LP on Dec 31st
Delayed Intensification Jan 26 - Mar 22
  • LP once a month (Jan 26, Feb 23)
  • IV Chemo (vincristine and doxorubicin) once a week for the first 3 weeks (Jan 26, Feb 2, 9)
  • Dexamethasone for a week following Jan 26th and Feb 2nd IV Chemo
  • Muscular shot of chemo, into the leg, once.
  • oral chemo (thioguanine, cytarabine) for 2 weeks Feb 23 - Mar 8
Maintenance Mar 23 - June 14 (12 week cycles repeat until Dec 1, 2010)
  • IV chemo (vincristine) once a month, followed by 5 days of dexamethasone
  • Oral chemo, mercaptopurine, every day, and oral methotrexate once a week
  • LP every 12 weeks (first day of each cycle)
Before she starts each phase her blood counts have to be at certain minimums.  If her counts are too low, the start of the phase is delayed until her counts have recovered.

All her chemo drugs seem to work in a different way to prevent cells from multiplying.  They don't actually kill the cells.  I think the cells die on their own, as cells do, but are prevented from multiplying, so there are no more cells made before they die. They inject chemo into her spinal fluid during an LP to make sure there are no cancer cells in her CNS.  This prevents the cancer from spreading to her brain.
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Leukemia

Leukemia is a malignant disease (cancer) of the bone marrow and blood. It is characterized by the uncontrolled accumulation of blood cells.

ALL starts with a change to a single cell in the bone marrow. Scientists are studying the exact genetic changes that cause a normal cell to become an ALL cell. The goal of treatment for ALL is to cure the disease. Children with ALL are likely to be cured of their disease. There are two parts of treatment for ALL, called induction therapy and post-induction therapy. The aim of induction therapy is to:
  • Kill as many ALL cells as possible
  • Get blood counts back to normal
  • And to get rid of all signs of the disease for an extended period of time.

This is called a remission.Patients with ALL often have leukemic cells in the lining of the spinal cord and brain. The procedure used to check the spinal fluid for leukemic cells is called a spinal tap. The cells cannot always be found in an exam of the spinal fluid.

To prevent leukemia in the central nervous system (CNS) leukemia, all patients who are in remission have the lining of the spinal cord and brain treated. Parts of the body that aren't easily reached with chemotherapy given by mouth or IV - such as the lining of the spinal cord and brain - are treated by injection into the spinal fluid.

More treatment is needed even after a patient with ALL is in remission. This is called post-induction therapy. It is given in cycles for two to three years. Post-induction therapy is given because some ALL cells remain that are not found by common blood or marrow tests. For most people, the postremission therapy drugs used are not the same drugs used during induction therapy. The doctor considers many things to decide the kind of post-induction therapy a patient needs, such as:

  • The patient's response to induction therapy.
  • Whether the patient has certain chromosomal abnormalities.
Visit www.lls.org/canada to read more, you can also order a free pamphlet if you like.

How it all Began

Well Paige had been complaining about pain in her leg for a couple of weeks.  Took her to the Dr., who decided it was most likely growing pains.  But later that week she could no longer walk, and was hanging onto furniture to support her weight. Took her to emergency. Many x-rays later, we were told that there was a spot of translucency on her right femur (thigh bone).  We would need to go to the orthopedic clinic at BC Children's Hospital to have it diagnosed.  During this visit to emerg they did blood work that came back with "odd" results.  But the pediatrician spoke with the hematologist at BCCH and more blood work was done, which I was told came out fine.

So we went to our visit with the orthopedic Dr. at the clinic.  Paige had a CT of her legs.  On cross section your bone looks like a donut (there's bone marrow in the middle).  At a particular spot on Paige's femur it looks like a bite has been taken out of the donut.  But they decided they weren't worried enough to open her up to see what it was. So we went home with a prescription and a huge load of frustration.

Paige didn't get any worse, but she didn't get better either.  She seemed to always be hurting herself.  You could barely touch her and she would cry in pain.  She wouldn't come to me anymore when she was hurt, and would run away saying "don't touch me".  I was very concerned.  She was covered in bruises, and it didn't seem that she was bumping into things that often. She bumped her elbow one day, cried, and then carried on playing.  But that night she screamed about the pain in her elbow until I gave her some Ibuprofen. I knew something was wrong, but I didn't know what to do.  We had already seen the specialist.

Luckily the orthopedic clinic called to see how she was doing.  They thought the pain would clear up on it's own.  When I told them she was still symptomatic, they said I should bring her back.

So back to the clinic we went. This time they did a very thorough exam, but Paige screamed in pain all of a sudden during the exam, when it had been okay previously.  So the did some repeat x-rays looking at her knee closely.  The Dr. said that the bone in her knee (basically the end of her femur) looked "moth eaten".  He was concerned that she was so pale and decided to send her for blood work to see if she had a bone infection.

Well that would have been a blessing.  As it was the lab began calling him, as they were very concerned about what they were seeing.  Her platelets (the cells in your blood that clot) and her hemoglobin (carries oxygen on your red blood cell) were very low.  The orthopedic Dr. called the hematology/oncology Dr. to come up and see us. 

Immediately we were given the devastating news that it was leukemia.  He assured us it was entirely curable, it would just be a long road.

The purpose of this blog is to give all our family, friends, and co-workers a place to get up to date info on what's happening and how we are doing. I have my laptop here and will be checking.  So far my email doesn't work, so it is best to facebook me, call me on my cell, or comment on the blog.