Tuesday 12 August 2014

The plan

"In war, whichever side may call itself the victor, there are no winners, but all are losers."
- Neville Chamberlain, British prime minister; July 3, 1938

    In the arms race against Dominic's leukemia, we are running out of options.

    The initial chemotherapy and subsequent bone marrow transplant failed to keep the disease at bay.

    So starting today, we are fighting disease with disease.

    I've written before about graft versus host disease. It's when the new cells from a bone marrow transplant wind up in a fight with the old (host) cells. One of the casualties of such a fight is cancer cells, so what you want is enough GVHD to kill the cancer but of course not the patient.

    Dominic never had GVHD from his bone marrow transplant. Now the plan is to take steps to force it on him.

    The first step is more chemotherapy. He'll get azacitidine for five days, injected not into his broviac line but painfully and deeply into his now 22-month-old body. There are no studies ever done on using this chemo on such a young patient, but we have to try it. We can't use drugs he's had before because the body can only handle so much of them in a lifetime, and besides they didn't ultimately work.

    Hopefully the azacitidine sets the cancer back. Side effects? Pretty typical for a chemo drug, including hair loss, nausea, pain, fevers, even anorexia. Because it has to go in with a needle and his blood counts are depleted to begin with, infections are also a major concern.

    We wait 23 days between cycles of chemo, watching him like a hawk and doing tests to see how his body is responding.

    There is some good news. He can get this drug as an outpatient, meaning he comes in to the Alberta Children's Hospital every day, receives the injection, but is then allowed to leave - presumably to Trish's parents' place 15 minutes away. Certainly not to Medicine Hat.

    Once two rounds of chemo are done we go into the next phase. DLI - donor leukocyte infusion - involves getting T-cells from his original bone marrow donor and giving them in hopes they start a case of GVHD. They're more likely to do so because T-cells are the blood's most specialized infection fighters; they go after anything foreign, including cancer and old host cells.

    This is ridiculously dangerous. Too much GVHD can kill a person. Then again, the cancer WILL kill a person. It's worth a try.

    He had a good weekend. His innocence is a blessing in times like this. There were many visitors, friends and family, and he gladly took their hands and led them on tours around the unit. Every morning he'd climb in his little red car and I'd drive him around, him waving to the nurses and laughing as I bowled him down the longest hallway.

    Ginger ale was gulped, crackers crept in to his diet but he still needs tube feeds at night.

    That's fine. He can have what he wants so long as we can see him smile. Like Mr. Chamberlain back in 1938, I don't think he's going to like what's next.


    1. Crossing all of my fingers and toes that this will work! You can do this Dominic! Kick cancer's butt!

    2. Love those smiles little guy, we are cheering for you from the forests of BC :)

    3. Your son's smile could move mountains. You are so right that ignorance is bliss; the only upside to how young he is to be in this battle. He literally doesn't know any difference. For all he knows all little boys have a hospital as a second home, a support/social network of doctors, nurses and hospital staff and these tests and tubes are just a part of growing up. The plan is clever and creative. Sounds better than just trying to repeat what you already did. I sincerely hope he handles it all well and you have more smiley days than not!