Isaiah 58:8
Then your light will break forth like the dawn, and your healing will quickly appear; then your righteousness will go before you, and the glory of the Lord will be in your rear guard.
On Kaylee's birthday we found out that she is in remission. She could not have had better results from her bone marrow aspiration. They found 0% minimal residual disease in her marrow. So the induction phase of her treatment was successful. She also had 'favorable' genetics, which means that her chromosomes are responding very well to the treatment and are the type that will actually help her treatment from here on out be effective. So, she is still in the 'standard' (low) risk category and her prognosis is good. At least 85% cure rate.
So, you may be wondering, if she is in remission, why is she still getting treatment? Well, with Leukemia being a disease of the blood, it is pretty much everywhere in the body. So even though she had 0% MRD, she still has Leukemia cells in her body. Blasts are baby cells that are supposed to mature and eventually die. Everyone has them. In a Leukemia patient, there is an overproduction of blasts and for some reason they stop maturing and dying. From what I understand, the continuation of treatment is to kill remaining Leukemia cells in her body and to basically re-teach her blast cells how to mature and die. That is why her cytogenetics test was important. And why it was good that she was found favorable. I'm not 100% sure about that, but that is my understanding at this point. So, on to the treatment plan...
Kaylee is now in the Standard Consolidation phase. This phase lasts for 4 weeks and we will go to the clinic every Monday. She is now taking an oral chemotherapy drug called Mercaptopurine once a day. Ryan has to give her this medicine because it is not safe for me to handle any chemo drug. He even needs to wear gloves himself. But she is taking this in pill form that Ryan cuts into quarters, so she takes 6 of those in the evenings. Yesterday she got her single dose of Vincristine through her port. She will not need that again during this phase. She also got a spinal tap and a dose of Methotrexate into her spinal cavity. She will have spinal taps and Methotrexate the next two Mondays. Day 28 is the last day she has to take her oral chemo and the end of this phase (Sunday 11/25).
Next is her first Standard Interim Maintenance phase. This phase lasts 8 weeks and she only needs to visit the clinic every 10 days. At each clinic visit, she will get a dose of Vincristine and a dose of Methotrexate; both through her port. During her visit on day 31 (should be around 12/26) she will also get a spinal tap and a dose of Methotrexate in her spinal cavity. This phase will last through January 6th give or take a few days. Since it is every 10 days, some of those days fall on weekends, so the dates could be a bit off from here on out. I will come back and edit as needed.
Beginning January 7th is the Standard Delayed Intensification phase. This phase is also 8 weeks and I can see why it is named 'intense.' She will begin taking Dexamethasone (her steroid) again, but only in bursts on days 1-7 (1/7-1/13) and 15-21 (1/21-1/27). She will also go to the clinic on the first three Mondays for Vincristine, Doxorubicin (another chemotherapy) given through her port (January 7th, 14th, and 21st). On days 4, 5, or 6 (Jan. 10, 11, or 12) , she will get shots into her muscle of PEG Asparaginase (a chemotherapy she has gotten once before through her port when we were in the hospital at diagnosis). On day 29 (2/4) she will go to the clinic to get a dose of Cyclophosphamide (another chemotherapy) through her port. Also beginning on day 29 she will get Cytarabine (yet another chemotherapy) through her port as well. She will get this drug 4 days in a row on days 29-32 and then again on days 36-39. Since this is the case, they may send a nurse to our house on the days following day 29 so we don't have to run to the clinic 4 days in a row for two weeks (2/4-2/14). Also on day 29 she will begin taking a different oral chemotherapy called Thioquanine. She will continue these until the end of the 8 weeks (2/17). She will have spinal taps and intrathecal (spinal cavity) Methotrexate on days 1 and 29. After this intense phase she will repeat the previous phase, the Standard Interim phase for the next 8 weeks which will take us to March 31st.
On April 1st she will begin the Standard Maintenance phase. This phase should be the easiest. She will go to the clinic once every 4 weeks to get Vincristine into her port. She will take her Dexamethasone (steroids) twice a day only 5 days each month. She will take oral Methotrexate once per week. She will take the oral chemo that she is taking this month, Mercaptopurine, once a day every day. And finally she will get intrathecal Methotrexate and a spinal tap once every 12 weeks. This phase lasts 12 weeks and just keeps repeating for 2 years. The two year time period will not start until she begins her first Interim Maintenance phase on November 26th. So, she should be completely done with treatment (barring any complications or relapses) November 26th, 2014! But most of that time will be the Standard Maintenance phase, so it shouldn't be too bad. I think she will also routinely have bone marrow aspirations, but we don't know of any specific dates at this time.
She is supposed to also keep taking her Lovenox (blood thinner) for at least 6 weeks. That takes us up to the last week of November. They will do another ultrasound to see if the clot is gone and if it is she may get to stop taking the Lovenox. But it is also possible that she will take it intermittently throughout her treatment. It all depends. But this is the plan...
Jeremiah 17:14
Heal me, Lord, and I will be healed; save me and I will be saved, for YOU are the one I praise.
Malachi 4:2
But for you who revere my name, the sun of righteousness will rise with healing in its rays. And you will go out and frolic like well fed calves.
We are still going strong, trusting God's will and faithfulness; trying to use this situation to bring Him glory; excited about the work He is doing in all of us through this trial!
