UPDATE ON DETAILS AND TREATMENT

JULY 5, 2005 10:41 PM Isabel Newton- Update:

Update:
I spoke with Jayme and Sarah Jane today… they are exhausted but after a 3 hour conference with the pediatric oncology team including nurse, doctor, social worker and pharmacist this is the current situation and information.

Research:
They have agreed to have the baby as part of their research program at Kingston General Hospital and Pediatric Cancer Clinic as this will ensure that the baby will get the newest and most up to date treatments/drugs available. They also feel that they don’t’ want their babies illness to be in vain, and they would like ensure that research information on Isabel’s illness may bring hope/help to other children who might experience this disease.

Excellent Care:
She is under the care of Dr. Marianna Silva, Pediatric Oncologist, Kingston General Hospital, Ontario for which we are grateful for her 17 years of work in this field and care for our little Isabel.
The wonderful Pediatric Oncology group which consists of the doctors, social workers, pharmacists and nurses-thank-you for all you are doing for our little one and our precious family.

Prognosis and Type of Leukemia
The prognosis is good in that is has been determined that it is the best type of ALL Acute Lymphoblast Leukemia. Please link to the following web site for more information on the particular type of disease that Isabel has and it’s treatments.
In Canada :
http://www.curesearch.org/parentsfamilies/newlydiagnosed/article.aspx?rticleId=48&StageID=1&TopicId=1&Level=1


Or in the United States:

http://www.nci.nih.gov/cancertopics/pdq/treatment/childALL/healthprofessional

They are being told that they won’t give them a prognosis (what her future health outcome is) at this time although she is in the best of the best situation that she could possibly be for complete recovery as this is a 80 % success rate cancer and if she responds to all treatments well and doesn’t’ experience complications that can be fatal like fevers and infections.

This First Month:
This first month as they begin the aggressive routine of putting the leukemia into remission will be a difficult month. I have included a link to show the steps of the process as accurately as I can,

http://www.curesearch.org/parentsfamilies/intreatment/medical/.


Starting Tomorrow: July 6th – Please pray.
The daily routine is dramatic for the aggressive treatments and they will begin tomorrow with the following By sedation they will:
 Insertion of a Port a Cath- Catheter: to allow access for her chemotherapy

http://www.curesearch.org/parentsfamilies/intreatment/medical/article.aspx?ArticleId=80&StageId=3&TopicId=78&Level=1

• 
  Spinal Tap:
  http://www.curesearch.org/parentsfamilies/newlydiagnosed/article.aspx?ArticleId=57&StageID=1&TopicId=2&Level=1

to include: as first round of chemotherapy directly into her spinal column. The first round of chemotherapy drugs will be started tomorrow directly into her spinal column for extra certainty that no “blasts” are hiding there. This procedure is known as Intrathecally (IT) – injected into the spinal canal during a lumbar puncture. This is a large blast of chemotherapy into the spinal fluid in case there are any cancer or developing cells trying to find “sanctuary or hiding” in the spinal fluid. http://www.nci.nih.gov/templates/doc.aspx?viewid=b4293987-e205-4a47-8b28-1120ddaf0a34&version=1§ionID=9

Painful Procedures:
Unfortunately Isabel must endure these Lumbar punctures several times in a month as well as Bone Marrow Aspirations several times in a month. Bone Marrow Aspiration or Biopsy: -A procedure in which a small amount of bone marrow fluid and tissue are removed to examine the cells in the bone marrow. Leukemia involves the blood cells which are formed by the bone marrow. Also, some types of cancer may spread to the marrow.
Some comfort measures:
They will be putting Emla crème
http://public2.bcm.tmc.edu/pediatrics/documents/4108.pdf

on her back prior to the lumbar puncture to lesson the pink prick.. it’s is mostly having to be held down and to stay still that will be her little challenge. For her bone marrow aspirations Jayme has insisted that she receive a sedation as it can be quite painful! That’s my son.. good father that he is!

The Regime over the next 3 years. (it will change somewhat in medications, frequency and type as the different stages are worked through).
Isabel with then begin her regime of chemotherapy that will look something like this:

STARTING JULY 6, 2005
Day 1 :spinal tap and cytarabine injection Cytarbine can decrease the number of blood cells in a child’s bone marrow. The child’s doctor will order tests before, during and after treatment to see if the blood cells have been affected by cytarbine.

http://www.curesearch.org/parentsfamilies/intreatment/medical/drug.aspx?DrugID=21

Days 1, 8, 15 22 : Vincristine by needle inserted into central line a drug that attacks the cells during various phases of division.
http://www.chemocare.com/bio/bio.sps?iBiographyID=7959

and
Daunorubicin into central line it is an antibiotic that is used only in cancer therapy. It slows or stops the growth of cancer cells in a child’s body

http://www.curesearch.org/parentsfamilies/intreatment/medical/drug.aspx?DrugID=29

Days 4,or 5,or 6, Peg-L-Asparaginase Inserted by needle into her muscle. Asparaginase is an enzyme that starves cells of external asparagine. While normal cells can make all the asparagines they need internally, the tumor cells become depleted and die.
http://www.curesearch.org/parentsfamilies/intreatment/medical/drug.aspx?DrugID=10

Everyday: Days 1 -28 twice by mouth dexamethasone - used to stop or reduce nausea or vomiting caused by cancer chemotherapy.
http://www.curesearch.org/parentsfamilies/intreatment/medical/drug.aspx?DrugID=25

Days 8, 28 Methotrexate - by spinal intracatheal spinal tap Methotrexate blocks a protein that cancer cells need to survive. The drug interferes with the growth of cancer cells, which are eventually destroyed. http://www.curesearch.org/parentsfamilies/intreatment/medical/drug.aspx?DrugID=87.

How are chemotherapy drugs given?
Chemotherapy is given in different ways depending on the cancer type and the drugs used.
Methods of giving chemotherapy drugs include:
Intravenously (IV) – injected into a vein
Intrathecally (IT) – injected into the spinal canal during a lumbar puncture
Intramuscular (IM) – injected into a muscle
Intraperitoneal (IP) – injected into the abdominal cavity
Intracavitary (IC) – injected into a body cavity
Subcutaneous (sub.q.) – injected just under the skin
Oral (PO) – as a pill or a liquid to be swallowed

Attacking even the Hidden Cells:

They will do this starting tomorrow with a large blast of chemotherapy into the spinal fluid in case there are any cancer or developing cells trying to find “sanctuary or hiding” in the spinal fluid. Please see : for an explanation of the type of cancer she has

http://www.nci.nih.gov/templates/doc.aspx?viewid=b4293987-e205-4a47-8b28-1120ddaf0a34&version=1§ionID=9

Blood Work results today:

From her Bone Marrow aspiration good news:

 Not may blast cells.(The bone marrow produces large numbers of abnormal cells, called blasts)
 best level pre b cell
 Best Candidate for known treatment success rate outcomes meaning that the she will not only be well but in the future cured and grow up to be a healthy girl!

 Hemoglobin: 90
 White Blood count: 4.7
 Neutrophils: 0
 Platelets: 94
 Lymphocytes 4.7
 Leucocytes: 4.7

CONCERNS: Fever and Side Effects.
Fever and neutropenia
Febrile neutropenia is a potentially life-threatening condition that occurs commonly in pediatric oncology patients. Understanding the scope of this complication and the need to initiate therapy rapidly can significantly reduce mortality.
Fever in a neutropenic patient is a one-time temperature of >38.5 or three temperatures of 38.0 in a 24-hour period. Patients who have recently undergone a hematopoietic stem cell transplant or those who are taking immunosuppressive medications may be considered febrile at lesser temperatures.
Incidence: The incidence of bacteremia in febrile neutropenic pediatric patients is estimated at 4% to 36%. The occurrence and nature of febrile neutropenia differ between the pediatric and the adult patient. This difference is due not only to the various types of oncologic diagnoses themselves, but also the intensity of pediatric regimens, the proportional usage of indwelling central venous access devices, and the immaturity of the immune system.
Sites: The most common sites of infection include central venous access devices, the alimentary tract (primarily the oral mucosa and the perianal region), and surgical sites. Anatomic infections frequently do not present with the typical signs of infections that are seen in immunocompetent hosts. Erythema, pustulation and induration may all be absent. Often the only symptom is pain.

Causes: There are many causes of fever in oncology patients besides infection. In fact, the cancer itself may elicit an elevation in temperature, known as a paraneoplastic fever. Other causes of fever include graft-versus-host disease, dehydration, blood product transfusions, obstruction of a viscus (kidney, bladder, bowel), CNS bleeds, thrombi and hypersensitivity reactions or withdrawals of medications.

Common Side Effects of Chemotherapy:
 Hair loss occurs when hair follicles are damaged by the chemotherapy. Hair loss can include scalp hair, eyelashes, eyebrows, axillary and pubic hair. The loss may be gradual, or it may happen all at once. Hair loss from chemotherapy is usually temporary; the hair will return, but it may be a different color or texture.
 Mouth and throat sores are caused by the destruction of mucosal cells lining the mouth and esophagus. They can result in minor to severe pain.
 Nausea and vomiting are due to a number of factors related to the effect of chemotherapy on the gastrointestinal tract and the brain. Currently, several anti-nausea drugs can be given prior to chemotherapy administration that will help prevent this symptom.
 Diarrhea may occur after chemotherapy because of damage to the intestinal mucosa and changes in the intestine's ability to reabsorb liquid. Constipation can result from chemotherapy's effects on the nerves of the intestines, which slows peristalsis, or the elimination of waste.
 Destruction of red blood cells by chemotherapy can lead to anemia. This can cause excessive tiredness, pale skin color, shortness of breath, irritability, decreased attention span, headaches and dizziness. These symptoms are primarily due to the decrease in oxygen going to the brain and other body tissues.
 Destruction of the blood platelets can result in bruising and bleeding. Known as thrombocytopenia, this is caused by a lack of sufficient platelets to form a clot and stop bleeding.
 Destruction of white blood cells can result in infections. White blood cells destroy bacteria, viruses and other pathogens, and are a major defense against infection. When white blood cells are low, infections can occur quickly and become very serious.
 Chemotherapy drugs may affect organs such as the heart, lungs, kidneys, liver, and brain, causing temporary or permanent damage. Some drugs may affect hearing. It will help to discuss each drug with your oncologist, to understand potential side effects and the probability that they will occur

Thank-you

We have provided this information to help all of you to understand what is going to take place of the next few years for our little one. Thank-you to all of you for your prayers and care for our little Isabel and her family! We love and appreciate you all. Candace and Family.