For the past two weeks Joseph has been on “holiday” from chemotherapy. His neutophil count was down to 0.1 so he was VERY susceptible to infection. But the Lord preserved Joseph again and he was well the entire two weeks. You can see from the first photo that he was really enjoying his time off from chemo. We found Joseph acting very much like he did before he was diagnosed. He was full of energy and liked to make wee jokes just to see if you were paying attention.
On Monday Joseph’s blood count was good, with neutrophils at 1.2. So he was scheduled to start the second half of delayed intensification.
On Tuesday afternoon I took Joseph in for his major infusion of this half block of treatment. Cyclophosphamide is a chemical decedent of nitrogen-mustard gas, a very powerful blister agent designed for use in warfare. An accident in WWII exposed several hundred troops to nitrogen-mustard and in the follow up medical care it was noticed that white cell production in the blood was suppressed. This led to the development of the very first “chemo” treatment for leukemia.
You might guess that infusing a chemical weapon agent into your two year old feels a bit odd. The amount of active agent is tiny but the list of really horrible side effects is long. To protect Joseph from as much as possible, they infuse extra IV fluids both before and after the treatment to “flush out” excess toxicity. This made for a long afternoon and evening of infusion. In the second photo you can see Joseph playing while hooked up to his drip on Tuesday.
The nurses warned us that this treatment can really make you nauseous so Joseph was treated with an anti-nausea medicine before his infusion and we were told to make sure and give him doses morning and evening for the next two or three days to help protect against strong nausea.
Joseph got two other drugs on Tuesday. One was Cytarabine, a drug whose active agent was originally extracted from Cryptotheca crypta, a sea sponge found in the Caribbean. Cytarabine is excellent at killing cancer cells but has its own long list of scary side effects. One of the less dangerous, but potentially inconvenient, ones is what is known as Cytarabine Syndrome, where the patient has a flu like reaction to the drug that produces a fever. This is not an infection but a type of drug reaction. Should Joseph have this reaction he would need to go into the hospital for 3 to 4 days of IV antibiotic treatment as it is not possible to tell the difference between a Cytarabine induced fever and one caused by an infection in the early stages.
The last drug of the day was Mercaptopurine, something that Joseph has had before. It was specifically designed to fool replicating DNA into using it as a building block for a new strand of DNA. However, Mercaptopurine does not behave well when incorporated into DNA and kills the cell. It too has a significant list of possible side effects.
All of these drugs share one property and that is they can have a serious impact on the immune system. So once again Joseph will be at high risk of infection during the last half of delayed intensification.
When I read the history of Cyclophosphamide I was struck by the idea that something designed to maim and kill vast numbers of people would be used one day as a way to kill leukemia cells in children. It reminded me of Joseph in the Bible who was sold into slavery by his brothers. He would one day become a high government official in Egypt and would have the power of life and death over those same brothers. When confronted by Joseph, as a ruler in Egypt, his brothers were terrified. But then Joseph said that what his brothers intended for his harm, God intended for Joseph’s good and th