It has been a couple of months since I have done an update, so this will be a quick post to catch up on recent events in Kurt's battle against ALL.
We really enjoyed the Christmas season and Kurt was able to rest a lot and recover from his last round of Hyper-CVAD B. Kurt's hemoglobin was really low for a few days around December 28th and he developed petechiae (small red bruises) all over his arms and legs. Thankfully, he was able to get two units of blood! Because the clinic didn't have an available chair, he had to have the transfusion down the street at Good Samaritan Hospital. It took several hours and I ended up picking him up around 11:00 PM, as no visitor were allowed. It was a long day, but the new red blood cells really helped him to feel better!
On January 8th, Kurt's bone marrow biopsy unfortunately showed that he still had 0.03% MRD. While it wasn't what we had hoped for, we took encouragement from the fact that his numbers continued to fall. Kurt's oncologist decided that it was time to switch things up and move from more traditional chemo to immunotherapy. She decided that Kurt would do 1-2 cycles of a drug called Blincyto (Blinatumomab). This drug specifically targets the B-Cells in Kurt's body with the CD19 marker. We had been able to hear about other patients' experience with this drug and were encouraged. It has had great success at getting people MRD negative and keeping them there! We felt that God was using this situation to make sure Kurt was able to reap the benefits of this drug.
On January 19th, Kurt was admitted to start Blincyto. The plan was that Kurt would spend the first four days in the hospital, so that doctors could monitor any reactions. If all went well, he would be discharged to finish the 28 day cycle at home with an infusion pump. Blincyto has a short half-life in the body, so it would need to be given 24-hours a day without pause. During the first 36 hours of treatment, Kurt experienced an immune response to the drug. This is expected but carefully monitored to make sure it doesn't get out of control. He ran a fever and felt like he had the flu. At one point, his blood pressure was a little low. Kurt was put on continuous monitoring and labs were also ran to make sure it wasn't an infection instead. After the 36 hour mark, the fever left and he started feeling great.
On the first day we were at UK, the nurses noticed that Kurt's PICC line seemed pulled out too far. They did an x-ray to confirm. We were soon surprised to learn he would be getting a new PICC line that night. Because of the nature of Blincyto, it is only paused once a day for a couple of minutes for the bag to be changed. Since Kurt got his new PICC line a few hours after the medication was started, he had the joy of having two PICC lines in for a little under 24 hours. He told me he was a "you pick two!" The removal the next day was quick and easy. I think the thought of it coming out was worse than the actual process!
Our insurance was slow in getting things approved for us to go home with the infusion pump. After many phone calls and time spent on hold, we were finally given the all clear to come home on January 28th. It ended up being a much longer stay than we thought! We were thankful that Kurt felt really well for the remainder of that stay. He was able to do some work in the hospital. We caught up on some movies and were able to go for walks each night after 8pm on his floor.
Nothing is better than being at home! We have been able to enjoy time at home since the end of January. What a blessing to be home and to have Kurt feeling well. Because Blincyto doesn't destroy all the cells as chemo does, Kurt's hair and beard quickly began to grow back. His hemoglobin has continued to recover and was a whooping 14.5 this week! He has been able to work every day and has had some busy days working from home. The children have enjoyed these more "normal" days too. Homeschooling is going really well for us and I feel so pleased with all the ground we have been able to cover during such a crazy time. This week, we will start our 24th week of school!
Kurt finished his round of Blincyto on February 16th. He claims the hardest part was carrying his fanny pack and trying not to get snagged on things! Blincyto is technically a 6-week treatment, even though the infusion is only 28 days. So, on March 1st Kurt had an other biopsy preformed. We received those results this week on March 10th. When Kurt's oncologist walked into the room, her first words were: "I have GREAT news!" Kurt is finally MRD Negative! We were both thrilled to hear that right now Kurt is Leukemia free. It was wonderful to hear those words but also sobering because we know that the biggest mountain is now right in front of us: transplant. Because Kurt's ALL took longer to reach MRD negative and because of the MYC 8 rearrangement that showed up in his initial diagnosis, we know his ALL is somewhat resistant and more prone to relapse. His best chance at a cure is through transplant. We know God can cure him and pray He is using transplant as the means to do it.
Kurt's oncologist told us that they have activated his donor and sent him some dates to choose from for donation. We are currently waiting to hear back if one of those dates works or if there will be a little delay. We were told if we didn't get a phone call on Thursday that things would be progressing. No phone call came, but we are still holding our breath a little until we hear from his transplant coordinator on Monday. If transplant is on schedule, it will happen as early as 2-3 weeks. If there is a delay, Kurt will need to do an interim dose of chemo or Blincyto to prevent him from going too long without treatment. This would push transplant back. We are trusting God to work everything out for Kurt's good.
Right now, Kurt will be repeating some of the testing that he already did to clear him for transplant. We don't expect any hiccups, but continue to pray he stays healthy. Before transplant, Kurt will also have an outpatient procedure to place a tri-fusion line in his chest to be used instead of the PICC line in his arm. Before receiving his stem cells, he will have 6 days of total body radiation and chemo to ablate his own bone marrow. Radiation will be 2x a day. It is a lot to take in. but we know God will help us and protect Kurt. After the 6 days of conditioning, on day 0, Kurt will receive new stem cells and a new journey will begin!
Please continue to pray for Kurt:
-for protection against illness or anything that would delay transplant
-for strength, for him to pack on the pounds, and stamina to endure transplant
-for protection against mucositis (mouth sores) during the first phase of transplant. We are told this is one of the most common and worst side-effects. Many patients have pain pumps and even feeding tubes for a period of time. This usually resolves once engraftment happens around day +10.
-protection against GVHD (graft vs host disease) post transplant
-protection against weight loss (he's always been a skinny guy--I'm trying to fatten him up!)
Please pray for his donor:
-for protection against illness
-for a smooth donation process and no side-effects
-pray that God will use this process to reveal himself to the donor, if he isn't a believer
Thank you for praying for our family and for journeying along side us! We are so blessed. Kurt has done so incredibly well with everything and I know that this just shows how God is taking care of Kurt and being so merciful to him. There's no other way to explain it!
We look forward to sharing more concrete days regarding transplant soon.
-Priscilla
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