Induction (4 weeks) *completed*
Consolidation (4 weeks) *completed*
Interim Maintenance 1 (IM1 - 8 weeks ending 8-07-2014)
Delayed Intensification (DI - 8 weeks beginning approx. 8-08-2014)
Interim Maintenance 2 (IM2 - 8 weeks)
Long Term Maintenance (2.5 years)
* Roadmaps for Induction, Consolidation, IM 1 detailed here. *
Delayed Intensification (DI) 56 days beginning approx. August 8
Jax will have peripheral blood work (from the arm, like a routine blood test) in Duncan, first thing in the morning on August 7 to see if his ANC and Platelets are high enough (ANC @ .75 and Platelets @ 75). Within an hour, we'll know if he reaches those criteria and will then immediately travel to Vancouver to begin Delayed Intensification at BCCH on Friday, August 8. We need to go to BCCH for this procedure as our Oncologist in Victoria will be away on holidays, and there is no one else in Victoria who can administer the intrathecal methotrexate. We have to be there for the Pegaspergase on Day 4 (Aug. 11) anyway, so it's not an extra trip - just a weekend at the new
Ronald McDonald House in Vancouver!
If his counts don't reach the minimum required to begin this phase, we'll try again in another week.
This phase of treatment is aptly named, and likely to be the roughest stretch since the first 6 weeks. He will receive a cocktail of 8 different chemo medicines over these 8 weeks, in addition to oral antibiotic (Septra) taken every Fri/Sat/Sun for the duration of his three year treatment, to protect against a certain kind of pheumonia that immunocompromised patients are susceptible to.
He's going to feel really crummy. Two of the eight drugs in this phase are known to severely affect his ANC (immunity), which will reach all-time lows for several lengthy stretches. We will have to be extremely vigilant about any possible exposures to viruses and bacteria. He will most likely lose the rest of his hair.
Day 1: *count dependant - ANC > 0.75 & Plts > 75 *
IT MTX (Sedated - Intrathecal Methotrexate)
IT MTX (Sedated - Intrathecal Methotrexate)
IV VCR (Vincristine)
IV DOXO (Doxorubicin)
This will be a very long day, as the LP for IT MTX takes quite some time and the DOXO requires substantial hydration before, during and after administration, so that his kidneys can properly flush the medicine.
This will be a very long day, as the LP for IT MTX takes quite some time and the DOXO requires substantial hydration before, during and after administration, so that his kidneys can properly flush the medicine.
Day 4:
IV PEG-ASP (Pegaspargase)
This drug is known to trigger allergic (and other) reactions, and only certain hospitals have authorization to administer it. He has had it once before, on Day 4 of Induction, with no reaction. However, subsequent doses are more likely to trigger an allergic reaction.
This drug is known to trigger allergic (and other) reactions, and only certain hospitals have authorization to administer it. He has had it once before, on Day 4 of Induction, with no reaction. However, subsequent doses are more likely to trigger an allergic reaction.
Days 1-7:
Oral DEX (Dexamethasone)
Oral Ranitidine (to protect his stomach lining from the DEX)
Oral Ranitidine (to protect his stomach lining from the DEX)
Oral Liquid Sweetener ("Orasweet" - to protect his taste buds from the awful taste of the Ranitidine)
Day 8:
IV VCR
IV DOXO
Day 15:
IV VCR
IV DOXO
Days 15-21:
Oral DEX
Oral Ranitidine (to protect his stomach lining from the DEX)
Oral Liquid Sweetener (to protect his taste buds from the awful taste of the Ranitidine)
Day 29: *count dependant - ANC > 0.75 & Plts > 75 *
IT MTX (sedated)
IV CPM (Cyclophosphamide)
IV ARAC (Cytarabine)
IV ARAC
Days 29-42
Oral TG (Thioguanine)
Interim Maintenance 2 (IM2)
56 days beginning approx. early October
IM2 is almost identical to IM1, except that it has one additional IT MTX (sedated lumbar puncture/spinal tap).
Day 1 *count dependant - ANC > 0.75 & Plts > 75 *
IT MTX (sedated)
IV VCR
IV MTX
Day 11
IV VCR
IV MTX
Day 21
IV VCR
IV MTX
Day 31
IT MTX (sedated)
IV VCR
IV MTX
Day 41
IV VCR
IV MTX
Long Term Maintenance will begin on Day 57, or when ANC and Platelets reach .75 and 75. More about LTM in another post, as it gets a little bit complicated. He will be on one of four potential treatment protocols.
Interim Maintenance 2 (IM2)
56 days beginning approx. early October
IM2 is almost identical to IM1, except that it has one additional IT MTX (sedated lumbar puncture/spinal tap).
Day 1 *count dependant - ANC > 0.75 & Plts > 75 *
IT MTX (sedated)
IV VCR
IV MTX
Day 11
IV VCR
IV MTX
Day 21
IV VCR
IV MTX
Day 31
IT MTX (sedated)
IV VCR
IV MTX
Day 41
IV VCR
IV MTX
Long Term Maintenance will begin on Day 57, or when ANC and Platelets reach .75 and 75. More about LTM in another post, as it gets a little bit complicated. He will be on one of four potential treatment protocols.
