A Day of Good News

Prayer Highlight: Today we received two very encouraging medical reports.  There are many details and context to these so I will give details below.

1) 98% Reduction in Leukemia cells in Josephs bone marrow

2) The genetic makeup of Josephs leukemia is not resistant to standard treatment

We feel that Lord has been answering prayer in mighty ways. So far Joseph has not only been preserved but has responded VERY well to treatment. Thank you for continuing to lift him up to the Lord.

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Joseph had a bone marrow test done the day before and we were asking for prayer that the results would be good. What they were looking for was how much of the leukemia had been eliminated from Joseph’s bone marrow. They have a threshold of 75% reduction that experience says if there is not at least that much reduction at a early stage of treatment then the leukemia is resistant to treatment and they would invoke a more aggressive treatment protocol. In Joseph’s case they did this test a bit early as they needed to do the lumbar puncture and decided that they would take this sample as well. If he did not meet the 75% reduction threshold they would repeat the test next week when it would be “on time” but if he already had 75% reduction early it would spare him another trip to surgery next week.

The consultant came to see me and said Joseph had a 98% reduction in leukemia cells in his bone marrow. Recall that when Joseph was admitted his bone marrow as 97% leukemia cells. Now under the microscope there were very few leukemia cells left in the bone marrow and she was very pleased with that progress. However, let me say this does not mean that the leukemia is gone or cured yet. It is a rather complex picture that I will expand on below.

The other piece of good news was initial results of the genetics testing done on Joseph’s leukemia. There are many variants of leukemia, some are more easily treated and others are more resistant to treatment. In Joseph’s case his leukemia  is NOT one of the resistant types. Again this is good news as it keeps him in a category of  treatment with fewer long term side effects.

So now what? Up to this point from a medical perspective all the news has been positive. Joseph has been preserved from the deadly infection, he has not had any immediate reactions to the treatment drugs and all his tests have indicated that the leukemia is responding to treatment. Now there is one more hurtle that will have a very big impact on Joseph’s treatment. This test is called the MRD or Minimal Residual Disease. When Joseph was admitted to the hospital they took a sample of his bone marrow and sent it off to a UK lab to search for unique genetic markers of Joseph’s leukemia cells. If they are successful in finding those they will use a VERY sensitive test in a few weeks to look at his blood and bone marrow for ANY detectible presence of leukemia. This test has a threshold at 1 in 100,000 or so (waiting to hear the exact level). They know that they should not be able to see any leukemia cells in the microscope but there will always be some leukemia there. As leukemia is a disease of the blood and the blood goes everywhere in the body leukemia cells go everywhere in the body. Experience has shown that children who have more leukemia detected than the MRD threshold will generally have a reoccurrence of leukemia if they are not given a much more aggressive treatment. This treatment has more long term side effects and there can be many more complications. I am told that about 50% of children test above the threshold. No one knows why children who are responding to treatment otherwise would have this higher level of “residual disease” but they do know that if it is present this is the time to tackle it.

The goal of all this treatment is to achieve “remission” or a type of retreat of the disease. In the case of leukemia 5 years with no disease is a “cure”. In general if a child stays in remission for more then 10 years it does not come back. To achieve lasting remission the treatment strategy is get the level of leukemia as low as possible and allow healthy bone marrow to develop. Then to keep putting pressure on the remaining very low level of leukemia and not giving it a chance to gain foothold again. In boys they maintain a level of treatment for 3 years, most of that as an outpatient who lives at home with his family. During that entire time there is always a risk of infection and side effects. Then after treatment there are long term side effects of treatment to deal with. As complex as this sounds, i