Thursday, June 19, 2014

2nd Round starts with bad news

Well we went in for the first treatment of the second round of Vidaza on Monday June 16, 2014 feeling pretty relaxed, only to be hit with disappointing blood test results.

Before beginning treatment they take his blood to check his white, red, platelets, ANCs, among other things. We waited for the treatment to start for some time until Todd's nurse came over and told us that Todd's blood counts were very low and she was waiting for his local oncologist to review the blood work results and make a decision whether to proceed with treatment today. The concern was that blood counts typically drop the first week of treatment.  If they are already very low to start with, they are very likely to go even lower, maybe dangerously lower. The doctor needed to evaluate this risk first.

We were in shock. We were still riding the high from the news of his elevated platelets. 

We quickly learned that the platelets had already started to drop before treatment because on his last appointment his local oncologist was looking at his results from the prior week without waiting to see that day's result before the consultation. In reality, his platelets had already dropped from their all-time high of 136,000 on June 2, 2014 to 85,000 on June 10, 2014.  While this number was still good, it showed a quick decline.

So, on the day he started this round, his platelets had dropped to 75,000, but this was not as bad as his white blood count that had dropped from a 3.5 on June 2 to 2.0 and his Absolute Neutrophils (ANCs) had gone from 2.4 on June 2 to 1.1 on June 10 to .4 on the first day of this treatment, June 16, 2014.  All his numbers had dropped below the normal range lows  according to this day's results.

He was in disbelief.  He questioned the results and I reassured him that there was no manipulating blood counts.  We both quickly realized that the Vidaza's positive results were short lived.  I began to cry realizing that the Vidaza was not likely to keep him a state of "remission" for long.  The need for the transplant was still there if not more so.  I think that fact became a true realization at that point: the transplant was inevitable.  

While sitting there, Todd looked at his messages from his transplant doctor at the Cleveland Clinic.  The cytogenics results were back confirming the same chromosomal abnormalities and deletions.  It was her desire to continue the Vidaza for at total of 4 rounds.  I said he would likely be ready for the transplant after numerous rounds of feeling bad from the Vidaza and knowing the results would be short lived.

The nurse returned with the green light from the doctor to begin treatment. While the doctor was concerned that his blood counts were very low, he wanted to continue treatment with the hope that eventually the Vidaza would begin working and would bring his numbers up quickly after the initial first-week dip.  She began with his pre-treatment medication of the Aloxi (which he will get every other day for nausea) and then began the 30 minute treatment of Vidaza.

Blood work will be repeated next Monday. 

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