Relapse Journey

Week 1, Day 5: Re-induction

It’s been an extremely busy week for us, hence the delay in my post. I was also waiting results.

Re-induction week 1, day 5.

Following a BMA on Monday 27/3, in a 300 cell count specimen 95% contained blast cells. This is consistent with relapsed ALL. No blast cells were found in her spinal fluid which is great news-the leukemia is contained in her marrow & has not spread to her organs!

As a collective family decision, Team Bella decided to participate in a randomized trial. Without participation, she would not have possible access to epratuzumab (50% chance following randomization). The first randomisation has placed Bella into the SR-B Arm of the clinical trial (UK protocol) instead of the SR-A (German) protocol. It is usually a 118 wk trial. Bella will receive induction, post induction & maintenance therapy according to the protocol.

After regeneration of blood count at day 35 (start of week 6) the cytological remission & the MRD status will be quantified. In layman’s terms, post-induction phase oncology team will do a BMA to assess if the chemo has worked-taking tissue sample from her bone marrow.

Bella will then be randomised to receive or not receive epratuzumab in addition to Consolidation. Epratuzumab is a monoclonal antibody which has been shown in studies to have favourable outcomes in paediatric ALL relapsed patients.

Day 35, if Bella’s MRD (>10 -9 more than 1 leukemic cell out of 10000 mononucleated cells) indicates she is not remission following high-dose chemo, she will have stem cell transplantation/immunotherapy which will be a bridging process to prepare her body for BMT (bone marrow transplant).

If MRD indicates remission on day 35, Bella would continue with maintenance.

It has been a challenging week for Bella healthwise as she commences the gruelling month of chemo. She has already received intrathecal methotrexate following an LP on Monday, dexmethosone, mitoxantone, vincristine, Peg-aspariginase & micafungan (as a preventative measure).

To make this journey manageable, she has had access to the study program, music, play & art therapy to provide structure to an otherwise very clinical day.

Some days she has been very lethargic, other times she has been motivated to get out of bed to walk around the ward & participate in various activities. We are mindful of the cytotoxicity of chemo & it’s side effects on her little body. So it’s a juggling act to prevent her from getting infections, magaging nrutropenia & constipation & many other potentially serious long-term health issues post chemo.

But we also know this treatment is preserving her life & we will always work towards allowing her to one day have a fairly, normal childhood.

I am a strong advocate of awareness & this is the reason we have chosen to share our very personal cancer journey.

Team Bella: Never give up!🎗🎗🎗🎗🎗🎗🎗

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