So, much has happened, I finally had to close out my last blog without including everything! I tried to work on that post for the past two days, but just didn't have the energy to finish it.
Todd's counts have come up some, but he still needed a unit of blood this morning, Tuesday, February 3, 2015. His whites went up from .9 on Monday to 1.1; his platelets went from 21,000 down to 13,000 yesterday and then up a bit today to 14,000; his hemoglobin went from 6.7 after arriving to 7.6 after his transfusions yesterday. His hemoglobin was still at 7.6 this morning, so they are currently giving him 1 unit of blood. From what I can tell, his ANCs were at .6 and have risen to .8 then to .9 today. So, he is above neutropenia level (<500).
He learned from the physician making rounds, that his blood cultures came back negative for infections. So, the reason for the fever was likely just a neutropenic fever. (See http://www.uptodate.com/contents/treatment-of-neutropenic-fever-syndromes-in-adults-with-hematologic-malignancies-and-hematopoietic-cell-transplant-recipients-high-risk-patients?source=see_link)
I put in a call to his BMT doctor in Cleveland yesterday, just to let her know what was going on. She called me back about 4:00 p.m. to discuss the situation. First, she said Todd was welcome to come back to the Cleveland Clinic if we weren't happy with Miami Valley. She thought Todd passed out probably because of the low blood pressure more so than the low hemoglobin, but it could have been both. When I asked if she was still planning on having him start his 3rd round of Vidaza on Monday, she said yes. As long as his ANCs are above .500 she was still wanting to proceed. I told her I was concerned about his counts dipping even lower after resuming treatment. She said, it would still be acceptable as long as they could be managed by transfusions, even if he has to get them often. She has decided to though to move up the bone marrow biopsy to a week after this next round of Vidaza. Nothing was said about doing a 4th round.
What was the most interesting information was that she has continued to check into the idea of enrolling Todd in that study for the new medication called AG-221 by Dr. Eytan M. Stein at Memorial Sloan-Kettering Cancer Center. http://www.mskcc.org/cancer-care/trial/13-154 (see Post: http://toddsmds.blogspot.com/2015/01/recommendation-stay-course-with.html). She researched Todd's medical records and found that Todd does have the gene deletion that is required to enroll in the study. In addition, there are no disqualifications for patients who have had a bone marrow transplant. As long as they have been off their treatment regimen (chemotherapy) for at least 14 days, they can participate. While the gene testing was done early on with Todd's initial diagnosis for clinic studies with his oncologist at the Cleveland Clinic, the test can be repeated "officially" for the record. She said that the Cleveland Clinic has not been approved at this phase of the testing to conduct the trial, but she said the closest location that is offering the trial is in Chicago, which isn't too far. While she's not ready to pursue this avenue right now, she likes the idea of having this option "in our back pocket" just in case. I thought this was encouraging news. I like that she listened and was open to researching my suggestion.
No appointments have been scheduled for Cleveland Clinic yet. She's waiting to see how this week and next week goes. But according to what she said, we will be heading back to Cleveland for a treatment appointment, bone marrow biopsy, and consultation with her around the last week of February.
Well, it is almost 2:30 pm and Todd just got his discharge papers. He is changing clothes and we are getting ready to go home! He has to follow-up with his local oncologist, or rather the physician's assistant (because his local oncologist is on vacation climbing Mt. Kilimanjaro) on Thursday morning at 9:30 a.m. at their office at Miami Valley South. I hope it goes smoothly and that they don't give him a hard time there about collecting his CBC.
His third round of Vidaza is still scheduled starting next Monday, February 9, 2015. They will do a CBC before starting. So, between these two appointments, they should be able to stay on top of his counts to see if he needs any transfusions. I think Todd has learned the hard way how important this is. He said if he would have gone in on Friday or even Sunday morning to get his blood work and transfusions done, he wouldn't have had to spend the last two days in the hospital.
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