Sometimes we just don't get the answers we were wanting, but that doesn't mean God has left us for one moment or that He isn't working to bring about healing in a way we didn't expect.
Kurt had his followup appointment to go over the results of the biopsy on day 29 of induction. Unfortunately, there was some residual residual leukemia in the bone marrow. The more interesting information regarding the biopsy was that the oncologist realized that these cancer cells have a "rearrangement" called MYC 8. This is a translocation within the cancer cells that can make them more aggressive and more prone to relapse. We didn't see this initially because it takes some super sensitive testing to look for it. The good thing is that the first biopsy to show the MYC 8 noted 12.5% and that number dropped to 1% with treatment. It did respond to chemo, but more is needed. Because of the presence of MYC, the course of Kurt's treatment will be pretty altered from what we thought. Instead of three years of chemo, attempting to avoid a transplant. He will now be on a transplant track.
Next Wednesday, Kurt will be admitted to start what will be 4 rounds of different and a bit more intense chemo called Hyper CVAD. The cycles of chemo are classified into A and B. We were told the B cycles are "harder" than the A. For the first cycle, Kurt will need to remain inpatient for 14-21 days. They need to see how he reacts to the new drugs and monitor him more closely. His discharge date will depend on how quickly his counts recover (a quicker recovery means discharge closer to 14 days). They will also be be able to give him medicines to help his counts recover with these chemo cycles. For the remaining 3 cycles, he will probably be inpatient for 5(ish) days and then home through the treatment and recovery. Of course, hospital stays and being able to remain home depend on a lot of things, but we are praying he can be home as much as possible! The cycles will progress A, B, A, B.
The goal of the Hyper CVAD is to get him into remission. The oncologist said she expects him to be in remission after two rounds...possibly after the first. There are also other drugs specific to B-Cell ALL they can use to get remission too, if these were to fail. As of now, Kurt won't be participating in the drug trial but the good news is that the drug in the study (inotuzumab) is something he can still take if needed.
Following the 4 cycles of Hyper CVAD, Kurt will move forward with a stem cell transplant. We don't know much details about this, as the transplant coordinator will meet with us next week. Thankfully, he has 4 amazing siblings who will go through the process to find out of they are a match. His best chances at a match come from siblings! They told us usually 1 out of 4 siblings are a great match, so we are praying one of them will be as perfect of a match as we could dream of! We don't have a firm timeline, but the oncologist mentioned the possibility of transplant around December/January.
So many things change quickly, so I am sure some of this could be revised in the future. We are still processing all this information and still have a lot of research and learning to do. It isn't what we wanted or expected to hear, but we are trusting that God is leading us down this path for a purpose. We believe that purpose is healing. I was so encouraged when I read the story of another B-Cell ALL patient who had a transplant at 41 and is now 71 years old! There are lots of risks with transplant and it certainly is the "scarier" thing we had hoped to avoid, but it also affords a chance at a cure.
The coming days are going to be stressful and long. We will be in for an intense phase of treatment and transplant until the beginning of 2021, but we know God will carry us through. One of the first things I thought was that we have so much help! Friends and family have seen us through this first phase, and we know we will continue to have that support going forward. We are so very thankful! I can't even express the joy that springs up in my heart when I think about each gesture of love.
Please continue to pray for Kurt. Pray that the treatments will work perfectly and that he will achieve the highest degree of remission. Please pray for his body, as he endures the treatments, and that he will retain his joy that has been unquenchable so far. Pray that we can find a perfect match for the transplant and that all will go smoothly in preparation for that process. Continue to pray for our children: each has dealt with anxiety and grief in different ways, but it as been especially hard for Hazel. Please pray that my own chronic health issues will remain in control and that I can be there to help and support Kurt. Pray we fix our eyes on Jesus and continue to trust Him. He has made a way for us so many times when there seemed to be no way--from adoption, to my own health issues, to Leukemia and we know He will continue to do so.
One song that I have had on repeat during this time is Andrew Peterson's "Carry the Fire." One section of the lyrics say,
Though your fears assail you
And your body may fail you
There's a fire that burns within us
Of a city descending
With the sun in the center
And a peace unending