Harrison’s monthly trip to the clinic today went exceptionally well. Today was a sedation day, meaning he was under sedation for a spinal tap through which Dr. Weston administered Methotrexate to kill the leukemia cells in his spinal column and brain. Because of Harrison’s stroke in December, millions of cancer cells rushed into his brain. Unfortunately, most relapses occur in the central nervous system, so oncologists inject chemo directly into the spinal column to fight the cancer.
Harrison was accessed and sedated, after which he received a splash of Vincristine, a drug we HATE with a passion because of its effects on Harrison’s joints, affecting his running. He went to visit some other cancer patients then headed out. The propofol (sedation agent) made him a little sick after leaving the hospital, but he felt better afterwards and headed to Chick-fil-A for the best chicken in the world.
In all, the clinic visit was uneventful. The best kind.
Unfortunately, though, Harrison absolute neutrophil count (ANC) was 400 today. Ideally, his ANC will be between 1000 and 1500 (a normal ANC is around 6000). Leukemia treatment calls for him to be in the immunosuppressed condition for the entire three and a half years in an attempt to kill all remaining leukemia cells.
Because his counts are low, Harrison is having some of his chemo withheld. He will continue with the Gleevec because it only affects the cancer, not his good cells. He’ll also take his steroid. He will not take his 6-MP for at least a week to see if his counts recover. You might remember, he was on a chemo hold for three weeks after his first month in Long Term Maintenance when his counts plummeted to zero and he needed nearly a dozen red blood and platelet transfusions. He also contracted a fungal infection and had to fight for his life. Scary time.
But childhood cancer treatment is about navigating between Scylla and Charybdis. On the one hand, there is cancer. Untreated the cancer would kill Harrison in a short amount of time. While most of the cancer cells have been destroyed in the treatment thus far, there still remain flowing through Harrison’s body thousands of leukemia cells, looking to hide from the chemo in “sanctuary sites” like the brain. Withholding the 6-MP prevents the continued attack against these enemy cells.
On the other hand, there is infection. Many of the kids who die from cancer actually die because of infections they contract due to decreased immunity. Whereas you and I have white blood cells to ward off infection, whether fungal, viral, or bacterial, Harrison does not. Or, at least not as many as he needs. This is why he takes an antibiotic (Septra) three days every week. But the Septra only protects him from a particular type of pneumonia which these kids are susceptible to contracting.
So Harrison will still take all the chemo except the 6-MP. We’ll check counts again next week. If they aren’t high enough he’ll skip the Methotraxate and continue the hold on 6-MP until counts rise.
He was already on 50% dosage, so he’ll probably start back at 25%. Dr. Weston will continue to track his ANC until he finds the right dosage to keep it steady in the 1000-1500 range. We’re looking for Goldilocks here: not too high, not too low, just right.
Harrison’s glad to be off these three daily pills, even if just for a week. And we’re happy for him. We are also glad that whatever dosage he ends up on, it will be less than the max, meaning fewer pills and less toxicity.