A good week

Jack is handling his chemotherapy very well. While it exhausts him, he still manages to keep a positive attitude. It really is amazing to see how strong he is.

Unfortunately, his play date options are really limited right now. The disease and its treatment make him vulnerable to the slightest thing. Since he can't really play with other children yet, you can see why everyone was thankful to have had such a beautiful (albeit windy) week in South Orange. Jack enjoyed many trips to the local playgrounds and parks, where he could enjoy watching his big sister romp with his playgroup friends, and also enjoy some QT on the swings.

Of course, there is still nothing better than cuddling with daddy and mommy!

Jack begins Week Three of chemotherapy tomorrow. Think of him often and say a little prayer, or two, or three.

All about remission

When my husband got home from work last night, our conversation went something like this:

Me: "Guess what? Jack's in remission!"

Him: "That's great!" Then there was a pause and his expression turned to bewilderment.

He continued: "Already? Wow." He paused again, and I could tell he was trying to process the news. He continued: "That just seems really fast, doesn't it? I mean, chemo just started, so what does remission mean?"

As I talked with him some more, it occurred to me that many of you might have had the same reaction: sheer happiness to have had such a positive result so quickly, and also many questions about what it all means. So here is a quick primer about remission.

Remember in the post a few days ago where we referenced Rapid Early Responders? Well, that's Jack. He bravely received very aggressive chemotherapy, and the doctors expected to quickly put his leukemia into remission. But there is still a long road ahead of Jack. His battle against cancer is a marathon, not a sprint. According to The Children's Oncology Group being in remission unfortunately does not mean that the Jack is cured, because without further treatment the disease will return.

So what is next? Once he completes Induction, there are three remaining phases of cancer treatment which can span 2-3 years: Consolidation, Delayed Intensification, and Maintenance.

Here is the summary Cure Search provides about those treatment phases:

• Consolidation: The second phase of treatment. This phase lasts from four to six weeks. Different drugs from those used during Induction are given by mouth and intravenously. This is to kill leukemia cells that may remain after the drugs used in induction. During this phase, another main focus is on treating and preventing the growth of leukemia cells within the central nervous system (CNS prophylaxis). To accomplish this, spinal taps with intrathecal chemotherapy (directly into the spinal fluid) are performed weekly. For certain types of leukemia, or if leukemia cells were present in the spinal fluid at the time of diagnosis, radiation therapy may be given to the brain and the spinal column during this phase.
• Delayed intensification: This is a phase that includes medicines similar to those given in Induction and Consolidation. This has been shown to be helpful in preventing leukemia from returning. The exact timing of the doses and the specific drugs used depend upon the individual characteristics of a particular child’s disease.
• Maintenance: The final phase of treatment. This phase of therapy lasts two or three years. Maintenance is much less intensive than the previous treatment and consists mostly of oral medications given at home. There are also intermittent intravenous and intrathecal medications given throughout this phase.

As you can see, while we can rejoice in the knowledge that Jack is winning his battle against cancer right now, we need to remember that he is still at war with leukemia. Continue to keep the Bailey family in your thoughts and prayers.

How do you spell relief?

R-E-M-I-S-S-I-O-N!

There were no cancer cells found in Jack's bone marrow! While he still needs to complete the Induction phase with the remaining scheduled intensive chemo treatments, the doctors are very pleased with how the drugs have worked thus far. Once Induction is complete, Consolidation Therapy will begin. Please sign his guestbook and celebrate the good news!

Round Two

"The future doesn't belong to the faint-hearted; it belongs to the brave."
--Ronald Reagan

Jack returned to the hospital this morning to undergo his second round of intensive chemotherapy. While he receives some chemotherapy drugs orally every day, today was a partial repeat of Round One. It involved receiving Vincristine through his portacath and Methotrexate using a needle inserted into the fluid surrounding the spinal cord. In addition, the doctors performed a bone marrow aspiration to see if the leukemia is responding to treatment. Jack handled everything in his trademark positive, brave manner. The Baileys are eager to receive the results of the bone marrow procedure tomorrow. Please keep them in your thoughts and prayers.

All about ALL

Since Jack's diagnosis, friends and family have wanted to know more about the type of leukemia Jack has and what his medical treatment involves. Below is a summary taken from documentation Anneli and Damond received from the hospital.

Jack has acute lymphoblastic leukemia (ALL). ALL is a cancer of the blood cells. It develops in the bone marrow, which is the soft tissue in the center of bones where blood cells are made. ALL is a cancer in which young, abnormal, infection-fighting white blood cells, called 'blasts', crowd out normal bone marrow cells and spread into the blood stream. Blasts can also spread to the brain, spinal cord, testicles, and other organs.

Jack has leukemia that is classified as Standard Risk (SR) because his white blood cell count is less than 50,000/microliters and he is at least one year old and less than ten. Based on his diagnosis of Standard Risk B-precursor ALL, the Bailey's were invited to enroll Jack in a clinical trial research study organized by Children's Oncology Group (COG). COG is an international research group that conducts clinical trials for children with cancer. The overall goal of the study is to see if the doctors can get rid of the cancer for as long as possible with acceptable side effects of therapy.

The family consented to participate in the clinical trial. The first stage of treatment is called Induction. The leukemia treatment in this stage is the same for patients who choose to be in the clinical study and those who do not. During Induction, the doctors try to remove all visible signs of leukemia and allow normal blood cells to be restored (this is called remission). Five chemotherapy drugs are used during this stage of treatment.

The five chemotherapy drugs are:
1. Cytarabine, which is a drug used to treat the brain and spinal cord and is given using a needle inserted into the fluid surrounding the spinal cord.
2. Vincristine, which is a drug given intravenously.
3. PEG Asparaginase, which is a drug given using a needle injected into the muscle.
4. Dexamethasone, which is a liquid steroid drug given orally twice daily.
5. Methotrexate, which is another drug used to treat the brain and spinal cord and is given using a needle inserted into the fluid surrounding the spinal cord.

Common side effects of the cancer treatment include nausea, vomiting hair loss, and fatigue. The most common serious side effect is lowering of the number of blood cells resulting in anemia, increased chance of infection, and bleeding tendency. In addition, risks associated with the drugs used include increased toxicities that can cause infections or make it harder to fight off infections, loss of healthy blood cells, and damage to bones or joints.

Induction lasts 5-7 weeks, and by the end of Induction, Jack's doctor will know the subtype of the ALL. During Induction, tests will be done on Jack's bone marrow samples to find out how well the treatment is working. These measurements will assess Jack's response to treatment and determine if stronger therapy is needed to reach and maintain a remission. (Patients are either classified as rapid early responders (RER) or slow early responders (SER). RER patients respond to treatment more quickly and go into remission faster, resulting in fewer courses of chemotherapy. SER patients respond to treatment more slowly and take longer to go into remission, resulting in more courses of chemotherapy.) Jack's bone marrow will also be tested at the end of Induction. Hopefully, there will be no more leukemia cells in the bone marrow, and the disease will be in remission.

Based on the study, the doctors should know how strong the rest of Jack's treatment needs to be to keep the leukemia in remission. Once the study doctors know the ALL subtype and how much leukemia is left in Jack's bone marrow, he may continue in Part II of the clinical trial for the next phase of therapy, called Consolidation. We'll summarize that phase when we get to it.

For even more information, you can download the COG Family Handbook for Children with Cancer by clicking here. You can also visit the National Cancer Institute website by clicking here.