Relapse Journey

Pre-B, ALL Relapse, Post BMT #2, Day 119

Yesterday, we attended RCH for a review in day oncology to obtain Day +100 MRD (Min residual disease) & Chimerism results for Bella done in theatre about 2.5wks ago. Di was very pleased with Bella’s physical recovery. On continuous nasogastric feeds, we had managed to reach our goal of 18kg projected healthy weight set by the dieticians for Bella.

However, when I went on to ask for the MRD results Di’s expression darkened slightly & she told me calmly, “Vanie, I am sorry to be the bearer of bad news, but we have detected a positive MRD from day +96 BMA tissue that was taken. Leukemia cells were present at the molecular level (10 to the negative 4).” 

I felt like I had just been hit with the 3rd freight train. It took about a minute for me to scrape my heart off the floor. I thought after all that Bella had endured, we were finally getting on with our lives. Apparently not. As I have said so many times before, once you are on this cancer train, you are given a life-long ticket that has no expiry date.

I. Did. Not. See. That. Coming. Following a flood of tears & me profusely apologising to Di for completely LOSING it at our consult after this development, I tried to compose myself. She was so supportive & patient.

My mind started to race. I had a million questions to ask our doctor. Where to now? Do we actually have options? CAR-T cell therapy? Will Bella fit the criteria??

This MRD results were retrieved ~1.5wks prior to Bella ceasing Cyclosporin (immunosuppressive drug). Without this immunosuppression, Di hopes Futoshi’s marrow will go to work & obliterate the new cancerous cells. Di also informed me there WERE options available for Bella.

Thank goodness! If the results of the MRD are positive, the first plan of attack would be to access stored Donor Lymphocyte Cells (DLC).

Every human being naturally has cancer cells in our body. For the majority, our internal defense (immune system) can attack the foreign cells.

Prior to transplant, Bella’s diseased marrow could not combat the leukemic B cells. This was due to Bella’s cytogenetics (i.e deletion p16 (tumour suppressive gene). However, we are hoping & praying that Tosh’s healthy marrow will do just this, because it is not diseased!

So, in 2 weeks, Team Bella will go back in for another BMA to obtain an MRD result. If the MRD result is negative, this will demonstrate that the healthy marrow is doing its job to kill the erroneous immature B cells.

Right now we wait with baited breath until the molecular results come through following the BMA on 30/1/18.

The good news is Bella’s chimerism is still >99% donor marrow. The engraftment has remained strong despite this latest development.

Thank you for your support, prayers & love.

Team Bella: Never give up!

“A Hero is an ordinary individual who finds the strength to persevere and endure in spite of overwhelming obstacles.” Christopher Reeve.

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