Monday, May 3, 2010

2400

Complete relief...more soon....
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2 comments:

  1. Grandma DMay 3, 2010 at 4:47 PM

    I thought I'd clarify for everyone what 2400 means. It's an ANC measurement, or Absolute Neutrophil Count, an indicator of how many white blood cells Alex's body is producing. In the case of T-cell lymphoma, the doctors want to see his ANC counts in the range of 750 to 1200, which is MUCH lower than normal. If his ANC drops below 750, then he is susceptible to infection, and it can be life-threatening. If it is higher than 1200, then that is an indicator that perhaps the chemo drug is not working properly to kill 'bad' white cells, which is what lymphoma is - a rapidly growing number of cancerous white cells, specifically T-cells that are involved in normal immune response. Normal white cells assist in killing off infections, but cancerous white cells do not do that.

    The drug Alex has been taking daily for the last 6 months or so is called mercaptopurine, and it is one of the drugs responsible for the 80 to 90% success rate in lymphoma and leukemia patients. Mercaptopurine kills white cells - both good and bad ones, so it's important to get the dose right to keep enough white cells around to fight infection, but not so many that the cancerous white cells have a chance to grow. However, Alex seemed to be 'hypersensitive' to mercaptopurine, and for the past 4 weeks his ANC counts were anywhere from 300 to 500, below the required threshhold of 750, so he hadn't been taking any of that drug. Not taking the drug could have allowed the 'bad' white cells to grow. Last week his count was 500, but the docs decided to wait one more week without the drug to see if his body would start producing white cells again. We have been concerned because it was now 4 weeks without mercaptopurine, but his counts were too low to start taking it again.

    Today we had good news: his ANC count went up to 2400. If his count had come in below 750, the docs would have done a bone marrow aspiration to see if the white cells had invaded that site causing fewer white cells to be produced. When he was first diagnosed, there were not cancerous white cells in his bone marrow, so we were all holding our breath until today's ANC count.

    The count of 2400 means his body had started producing white cells, but 2400 is too high, so they immediately put him back on mercaptopurine, but at 50% the normal dose. That will continue for a month to see if they can keep the correct ANC range between 750 and 1200.

    Much of the trick with managing chemo is getting the dose right: you want to kill 'bad' white cells, but keep enough around to fight off other types of infection. So, we never want to see a number that is too high, other than in a case like this one which was 'Why are his ANCs staying so low for so many weeks?' We want that ANC range to be between 750 and 1200.

    Research is being conducted in clinical trial on using immunotherapy drugs, which target cancer cells only, rather than chemotherapy which kills ALL rapidly dividing cells, good ones and bad ones. Chemo has such harsh side-effects (hair loss, joint pain, and more), and I'd sure like to see immunotherapy being used in place of chemo. But, Alex's doctors chose chemo because the particular protocol chosen has good outcomes.

    Alex is a brave little boy, and we are so proud of how he handles these nasty drugs and their side effects. I remain confident that he will beat this terrible disease.

    Diana (Sara's mom)

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  2. JoniMay 4, 2010 at 9:24 AM

    Thank you so much for the info Diana...I know the whole family has been just on the edge of their seat, and I'm relieved that things are looking up.

    You don't know me, but I'm a very good friend of Gale's so have been watching this journey.

    I admire the strength you all have!

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