Feb 4th - Definitive Diagnosis

We rested on Saturday the 4th. No big plans. Colin came over in the afternoon to watch a movie with Jessie. We got the call from an attending at Children's. It is APML - Acute Promyelocytic Leukemia. We sat and listened in shock while the doctor explained everything on speaker phone. Then Mike and I went downstairs where Colin and Jessie were watching a movie. We told them we had the answer- APML. Doctor said we need to come back tonight to be monitored due to the risk of bleeding and to start treatment right away. Jessie wanted to take a shower. I told her to be careful and not fall in the tub. The doctor had asked her yesterday about bleeding gums while brushing and bruising easily. She had noticed these things lately. She had a new bruise on her thigh that she didn't know where it came from. After the shower, we picked up our overnight bags and loaded them in the car. On the way to the hospital, we dropped off Colin at home. He gave her his tablet to use in the hospital. "It has Netflix. She can watch lots of movies" he said.  "See you whenever" Jessie said. Little did she know, she would see him the next day.

We checked into the hospital by going straight up to the floor where our new home away from home will be for the next 4-6 weeks. 4East. Hematology/Oncology.  The doctor was at home putting her kids to bed and would be back to greet us. IV was started. Bloods drawn. Getting settled in her new room. Checking out the TV and games. She kept her phone by her side texting now and then. Doctor came by and went over the game plan. There is a clinical trial that she qualifies for. Less bad chemo drugs to see if we come out with same outcome- cured. After consulting with our secret contact who has lots of experience with clinical trials, we decide that it's a win-win. Less drugs, less side effects.

Treatment of acute promyelocytic (M3) leukemia

Early diagnosis and treatment of acute promyelocytic leukemia (APL), the M3 subtype of acute myeloid leukemia (AML), is important because patients with APL may develop serious blood-clotting or bleeding problems. This used to be treated with blood-thinning medicines, but is less often a problem now that treatment includes drugs like all-trans-retinoic acid (ATRA). Other treatments might include transfusions of platelets or other blood products.
The treatment of most cases of APL differs from usual AML treatment. Initial treatment usually involves an anthracycline chemotherapy drug (daunorubicin or idarubicin) plus the non-chemotherapy drug, all-trans-retinoic acid (ATRA), which is a relative of vitamin A.
This treatment induces remission in about 80% to 90% of patients.
Patients who can't tolerate an anthracycline drug may get ATRA plus another drug called arsenic trioxide (Trisenox). The most serious possible side effect of this drug is a change in heart rhythm.
As with other subtypes of AML, patients with APL then receive post-remission treatment.
Consolidation therapy usually consists of 2 or more courses of chemotherapy (with an anthracycline), usually along with ATRA. Those who can't get an anthracycline usually get ATRA plus arsenic trioxide for several cycles.
Consolidation is often followed by maintenance therapy with ATRA for at least a year. Some doctors may also add low doses of chemotherapy, usually with the drugs 6-mercaptopurine (6-MP) and methotrexate.
The possible side effects from the chemotherapy part of this treatment are generally the same as those of standard AML induction chemotherapy. But both ATRA and arsenic can cause a problem called differentiation syndrome (it used to be called retinoic acid syndrome). Symptoms include breathing problems due to fluid buildup in the lungs, low blood pressure, kidney damage, and severe fluid buildup elsewhere in the body. It can often be treated by stopping the drug for a while and giving a steroid such as dexamethasone.

About 70% to 90% of patients with APL are cured with treatment.