There is one constant in the fight against childhood leukemia: the fear of relapse. Not a day goes by that parents aren’t worried that the cancer will return. Every bruise is seen with suspicion. Every headache, backache, leg ache is a reminder that, at any moment, the leukemia could rear its ugly head in mockery of the months (or years) of toxic chemotherapy. Too many kids fight for their lives during therapy only to relapse once the chemo stops.
Yesterday was the first time we had to face what we thought was evidence of potential relapse.
The nurse practitioner stopped by Harrison’s little cubby to give us his blood counts. Instead, she said they would draw more blood and run the test again as his white blood cell count was high and she wanted to make sure there was not a mistake. Last week his ANC (absolute neutrophil count) was 718. Yesterday it was 10,900. Yep, that’s correct, almost 11K.
My heart stopped.
She didn’t appear worried (and in fact said she wasn’t worried), but they are trained to handle things like relapse without becoming overly emotional.
As she walked away all I could think about was relapse. Ginger and I looked at one another, both thinking the same thing, but didn’t say a word, as though our silence would make the leukemia go away.
The NP never said anything about relapse. Never indicated it was even possible. Didn’t matter; that’s the one fear that is universal for families of cancer kids.
There were two things I didn’t know at the time. Both of them would have keep my mind from racing to relapse.
First, high neutrophil counts are not a sign of relapse. Harrison has lymphoblastic leukemia. His leukemia cells are lymphoblasts, or lymphocytes. The type of cells we are worried about are deformed lymphoblasts, not deformed neutrophils.
Second, the steroids’ job is to force more of all stems cells to mature quickly so they will be forced out of the bone marrow and into the blood stream where the chemo can kill them. His counts are supposed to be high. Duh!
Here is where remarkable researchers have produced a treatment plan that is amazingly complex and simple at the same time.
Stem cells eventually become other cells. Some become neutrophils, others become lymphocytes. If the cells have the corrupted DNA that make them “leukemia” they need to be destroyed before they reproduce. But if they are hiding in the bone marrow, the chemo can’t kill them. Steroids force them to mature and leave the marrow.
So after a week of steroids Harrison’s blood stream is filled with these white blood cells (and red blood cells as well, but that’s of little consequence in leukemia treatment).
But the chemo will kill nearly every white cell off this week. The docs expect that by next week he’ll perhaps be neutropenic and need a blood transfusion.
What was initially a cause for grave concern became a sign that the treatment is working. Week one: force all the cells into the blood stream so that if there are any leukemia cells they can be killed. Week two: kill all those cells.
In an instant fear turned to joy. Mourning became rejoicing.
Psalm 126 has yet again come full circle.
This will not be the last time we’ll fear relapse. Unfortunately, for the rest of our lives we’ll worry about every abnormality or illness. Never again will a virus be “simple” or a fever be “normal.” But there is One who casts out all fear. We’re learning to trust Him even more every day.