A Post By My Mom...

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. In Alex's case, the type of white cells are T-cells that are involved in normal immune response. Normal T cells assist in killing off infections, but cancerous T-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 (T-cells in Alex's case) - 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 little drug 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. During these past 4 weeks he hadn't been taking any mercaptopurine, which means that 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 good white cells again. We had been concerned because he'd gone 4 weeks without mercaptopurine, but his white cells counts were too low to start taking it again.

Today we had good news: his ANC count went up to 2400. If his counts had come in below 750, the docs would have done a bone marrow aspiration to see if any 'bad' white cells had invaded the marrow. Cancerous white cells in the marrow can grow and outnumber good white cells that are produced there, causing leukemia. When he was first diagnosed, there were no 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, because some of those cells could be cancerous. The docs 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 good white cells around to fight off other types of infection. So, we never want to see a number that is too low or 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 the use of immunotherapy drugs, which target cancer cells only, rather than chemotherapy ,which kills ALL rapidly dividing cells both 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 this particular protocol 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)