Today was better, slightly better, than yesterday. Wouldn’t it be awesome if I can say that everyday?
The increased doses of pain killers are definitely helping contain the pain from mouth sores, but she is very drowsy, sleepy, and in a constant dizzy state. Most of the time it looks like she is sleeping but she is awake and responds by nodding, but does not want to talk. She ate like 3-5 spoons at each meal. If somehow the mouth sores can be controlled without the pain killers I think she’ll bounce back quickly. I hope each of day gets slightly better.
Rachana’s oncologist Dr. Prapti Patel spent some time with me on the phone. She was very responsive to my questions about other treatment options including Immunotherapy which was in the news yesterday. She explained that Rachana is young (anyone under 40 and generally healthy can medically be a young adult), does not have any other health issues and was negative for the philadelphia chromosome; those factors contributed to the decision to go with this more aggressive treatment plan called CALGB vs. the more commonly used Hyper CVAD treatment plan. Since Hyper CVAD is not aggressive, it can sometimes be matched with other clinical trails like Immunotheraphy but CALGB does not call for it.
The doctor explained that the real test of progress will on day 28 (Apr 26) when they will do another bone marrow biopsy and that can result in 3 possibilities.
- If the bone marrow shows less than 5% blasts (lymphoblasts i.e. leukemia cell i.e. cancer cells) then she will officially be in remission, the ANC will also have to be high to protect against infections, and she will be sent home. The second phase of her treatment as a outpatient will start at that time.
- If the bone marrow shows 5% or slightly around 5% blasts, they will probably extend the induction phase by 1-2 weeks to get it under 5%. Rachana will continue to be in the hospital and the same chemo routine extends by 1-2 weeks.
- If the blast cells are significantly more, they will have to re-evaluate the situation and repeat the induction phase with some other combination of drugs.
The doctor added that she expects Rachana to be in remission at the end of these 4 weeks. She has done well in almost all tests; the odds are in our favor!