Dayssi by the numbers: The Technical Stuff

This entry is for all of you pre-meds who, like Jim, managed to avoid actually going to medical school but remember enough to be a pain in the petard to real doctors.

A caveat however:

“Not everything that can be counted counts, and not everything that counts can be counted.”

--Albert Einstein

Dayssi’s recent bone marrow aspiration (BMA) results from Day 8 came back showing 17% lymphoblasts. This is down from 94% at initial diagnosis and suggests a good initial response to treatment: The good guys are winning. We are hoping she is down below 5% by next week's BMA tests.

Some Other Numbers

WBC Blasts Platelets Hemoglobin ANC

Day 0 35 K 92% 135 K 5.5 400

Day 3 10 K 57% 70 K 7.7 100
Day 6 2 K 8% 46 K 12.6 90
Day 8 1.6 K ** 26 K 12.1 20


WBC = White blood count
ANC= Absolute Neutrophil Count
Blasts = lymphoblasts

The Treatment Protocol

Dayssi is being treated on the Children’s Oncology Group's Acute Lymphoblastic Leukemia protocol (a clinical trial)

This protocol has three phases: induction, consolidation, maintenance.

The basic induction treatment is below:

Outline

This is a 2-part, partially randomized, multicenter study. Patients are stratified according to early response to study induction therapy (rapid early response [standard risk (SR)-low or SR-average acute lymphoblastic leukemia (ALL)] vs slow early response [SR-high ALL]). After completion of induction therapy but before proceeding to part II therapy, patients are assigned to 1 of 3 groups based on stratification.

Part I

* Induction therapy: All patients receive cytarabine intrathecally (IT) on day 1; vincristine IV on days 1, 8, 15, and 22; dexamethasone IV or orally twice daily on days 1-28; pegaspargase intramuscularly (IM) on day 4, 5 or 6; and methotrexate IT on days 8 and 29 (and days 15 and 22 for patients with CNS3 disease).

Patients are assessed for response on day 29. Patients with M1 bone marrow AND minimal residual disease (MRD) < 0.1% OR MRD ≥ 0.1% and < 1% proceed to therapy in part II. Patients with M2 bone marrow OR M1 bone marrow AND MRD ≥ 1% proceed to extended induction therapy. Patients with M3 bone marrow are removed from the study.

* Extended induction therapy: Patients receive dexamethasone IV or orally twice daily on days 1-14; vincristine IV on days 1 and 8; pegaspargase IM on day 4, 5, or 6; and daunorubicin IV over 15 minutes to 2 hours on day 1.

Patients with M1 bone marrow and MRD < 1 % after extended induction therapy proceed to therapy in part II. Patients with M2 or M3 bone marrow after extended induction therapy are removed from the study.