Friday, August 15, 2008

Remission: Yes, No, Maybe, Circle All!

Amanda is technically both in and not in remission.

Her blast count is below 5%, the chief determinant of remission. Normal blast cell counts are 3.2%, whereas leukemia can be (but generally is not) diagnosed at 3.4%.

However, more modern testing of that <5% shows that her blast cells are "abnormal", which is the new gold standard.

So she's both, which has implications for her treatment options. Transplant is not off the table, but now we're just looking at managing the sickness in preparation for the transplant (transplant on patients with active leukemia are generally not successful as it takes 2 - 3 months for the new immune system to start working, and post-transplant chemo is not an option).

So she was given 3 choices:

1. HIDAC (High-dose ARA-C), aka consolidation therapy -- what she's had the last 2 times.
2. FLAGG (fludarabine / idarubacine), aka induction therapy -- what she had the first 2 times.
3. Clinical Trial

The argument against the first two is that they've both failed to keep cancer at bay. FLAGG didn't work the first time at all, and HIDAC hasn't kept the cancer away long enough between treatments.

The argument against the 3rd is that it's a trial. There are no proven results, no statistics, no way to predict the future. But the trial offers the hope that a new set of tools presents an attack vector the the leukemia doesn't know.

The trial would take 2 weeks, and she'd be in the hospital the whole time (except weekends), and she'd take 3 pills / day and one 4.5 hour transfusions on days 1 and 8.

If she forgoes the trial, they can try to use FLAGG and/or HIDAC to keep the cancer in small enough enclaves to have no real effect on her transplant. Either way, she can move from one treatment option to the other at her choice.

Amanda has just over a week to ruminate on the options, but the medical staff will also discuss and make recommendations next Wednesday (they have a weekly meeting on Tuesdays to discuss all patients).

No comments: