Okay family and friends... it is time to CELEBRATE!!
Carl is officially being moved from Induction to Consolidation in his chemo treatments. Here is some information we have about the different stages to the treatment.
#1 Remission induction: The purpose of the first phase is to bring about a remission. A remission means there are no signs and symptoms of the cancer. More than one chemo drug is used and high doses are given. This phase lasted 40 days.. THAT'S TODAY! An additional treatment that Carl got was to keep the leukemia cells from spreading to the central nervous system This involved a high-dose chemo, put right into the spinal fluid. Induction Chemo can have the most serious side effects, including infections. This is part of the reason why we were in the hospital for 24 days... the doctors want to keep a close eye on Carl. This is also why Carl is on so many antibiotics.
#2 Consolidation: Because Carl is considered to be in remission, the next phase is a fairly short course of chemo using many of the same drugs in high doses that were used before. This treatment phase lasts for 56 days. Central nervous system treatment will be continued at this time (These are the spinal taps). This phase of treatment is less intense (and less risky) than induction.
#3 Maintenance: Once the number of leukemia cells has been reduced by the first 2 phases of treatment, this last phase can begin. Maintenance, which usually means lower doses of chemo drugs, lasts about 2 years. Central nervous system treatment may also be continued. -- We are not here yet!!
Okay, so now that you know what the treatment stages are here is a little bit about Carl...
We will hopefully start Day 1 this Tuesday. Carl will be getting Spinal Taps weekly for a month and will be adding some additional medications. If all goes according to plan he will Start on Tuesday, February 28, and finish on Monday, April 23. Everything should be able to be done out-patient. Only thing that would require him a overnight stay will be any side effects of the chemo... GREAT NEWS!!! (Sorry 4th floor Bronson, we love you... but don't really want to come visit you!!)
Now... Information about Bone Marrow Transplant.
The purpose of a Bone Marrow Transplant is to increase the percentage of long term survival.
Doctors consider a patient will A.L.L. one of two risks, Standard or High ... They measure this on 3 main things.
#1 Number of White Blood Cells(WBC) - If you have over 30 (Thousand) WBC when you are diagnosed with Leukemia you are considered High risk--Carl had 29
#2 Minimum Residual Disease (Response to Chemotherapy)- If you need to repeat your induction phase of the chemo treatments in order to have a remission you are considered high risk-- Carl was in remission on day 15 of the 40 day induction cycle
#3 Chromosome Abnormalities * (See note below for information about how this happens)- You are considered high risk if you have more than 5 abnormal chromosome's.-- Carl has 3 **(See below for the number of cells a human should have)
So, Carl is not considered high risk on any of the three mentioned factors to risk. At the current time, we have been advised to not proceed with a transplant.
Again, the purpose of a Bone Marrow Transplant is to increase the percentage of long term survival.
High Risk ALL patients have a significantly lower chance of survival, therefore, a transplant is recommended to increase the chance of survival.
Standard Risk ALL patients, AND patients who receive a Bone Marrow Transplant are at an equal chance of long term survival, therefore, a transplant would have zero benefit for Carl. A transplant would also expose Carl to a higher risk of infection, and he would have to deal with graft versus host from the donor bone marrow. ***(See below for graft versus host)
As far as Carl goes.. .He is doing well, he is still cooking and doing dishes...and still has his sense of humor. He is having some cabin fever right now, and is looking forward to warmer weather so he can lay outside in a hammock... you should of heard him talking about it this afternoon, as the snow was flying....
* Chromosome Abnormalities
Chromosome abnormalities usually occur when there is an error in cell division. There are two kinds of cell division.
1. Mitosis results in two cells that are duplicates of the original cell. In other words, one cell with 46 chromosomes becomes two cells with 46 chromosomes each. This kind of cell division occurs throughout the body, except in the reproductive organs. This is how most of the cells that make up our body are made and replaced.
2. Meiosis results in cells with half the number of chromosomes, 23 instead of the normal 46. These are the eggs and sperm.
** Number of Chromosomes in a Human
The typical number of chromosomes in a human cell is 46 - two pairs of 23. One set of 23 chromosomes is inherited from the biological mother, and the other set is inherited from the biological father.
*** Graft Versus Host
Graft is what the donor bone marrow is referred to during a transplant. Graft versus Host occurs when the new bone marrow attacks other places in the body, most common places where graft versus host occurs is on the Skin, eyes, and mouth..causing severe dryness and rashes. Less common places that it is seen is in the gut, liver, and lungs.