Johnny's afternoon labs showed his WBC down to .8! His blast count is also dropping, and is down to 19%. So he doesn't have many white cells left, and of those he does have only 19% are cancer blasts. As nasty as the Clofarabine is at least it is working against Johnny's AML. I'm excited at his progress, but I hate to see what this chemotherapy is doing to him. Johnny's hands and feet are very swollen and dark red. It looks like he's been soaking them in boiling water. I wouldn't be surprised if the skin starts coming off soon. He has to be in a lot of pain, but he won't complain. I know his feet hurt because he can't stand at all, but I usually have to make him push the button on his morphine. If it was me I would hitting that thing as often as possible. I would also be crying like a baby, but I don't think Johnny has shed a tear or complained once during the whole three + months he has been in the hospital.
So what's next? Getting Johnny's WBC down was just the first step towards a bone marrow transplant. Now we will have to watch his counts closely for any indication that the AML is still active. The doctors are pretty confident that the Clofarabine has pretty much wiped out his marrow, so they doubt that will happen, but this is Johnny so nothing can be ruled out. Our next priority is to get his spinal cord clear of blasts. His next spinal tap (LP) will be sometime tomorrow, and he will get a combination of three chemotherapy drugs. They usually only use one at a time, but at this point I would be cool if they threw the kitchen sink in there also. Nothing should be held back. If tomorrow's tap is clear he will still need to get two more LPs to make sure there is nothing hiding in his spine. If he stays in remission, and we get the spine clear Johnny will be "rushed" to transplant. I say rushed because treatment for AML is typically several months, but in Johnny's case the doctors want to get him to transplant before his cancer has a chance to adapt to treatment.
Johnny's immune system is completely compromised at this point, and will stay that way until well after the bone marrow transplant. Apart from keeping his cancer in remission, keeping him from getting sick will be the major battle. If Johnny were to get another bacterial infection or a pneumonia it wold be very difficult for him to recover. He has fought these types of bugs before and beat them down, but he was much stronger then, so we want to avoid a rematch if at all possible.