M.R.D.

Yesterday was by far the happiest day of our life!!  I started to get nervous and anxeity filled Wednesday evening with the realization of what the M.R.D. result would possibly mean for our T.L.P.'s future and treatment.  I phoned the PAU unit at Kapiolani a few minutes after they opened to see if her results were in but was told the doctor would call me in about an hour.  I couldn't breath...

Dr. Des phoned me in just a few minutes and told me the MOST BEAUTIFUL words I had ever heard!  "Good news Heather, we found LESS THAN 0.01 percent of cancer in her bone marrow!"  We all cried tears of joy on our little Trevor's 3rd birthday and had such a wonderful day!  Happy Canada Day to all of our family and friends in Canada!

Complete remission - the absence of any signs of disease - is determined by analyzing bone marrow samples for Leukemia cells.  In the 1990's, technicians could only measure the number of leukemia cells to an accuracy of 1 cell in 100 cells, and at that time, complete remission was defined as less than 5 percent leukemia cells.  By 2009, tests at the molecular level for minimum residual disease (M.R.D.) could detect the number of leukemia cells to an accuracy of 1 cell in 10,000, or 0.01 percent.  Increasingly, researchers are incorporating the concept of MRD into their definition of remission for several types of leukemia.

Current treatment plans for ALL incorporate a "traditional" definition of remission of less than 5 percent leukemia cells and a definition of remission using MRD values.  Since 2009, the Children's Oncology Group (COG), the group that Carmen is a member of, defined MRD Remission as anything less than 1 percent and full remission as anything less than 0.01 percent.

The tests that Carmen received on Tuesday were gathering data to be measured for MRD.   We needed to wait until yesterday for the results and it was worth every second.

Not only that,  Carmen's doctor let us know that after 8 days of treatment, Carmen's leukemia cells we at 0.03 percent, meaning that her quick response to the chemotherapy treatment put her cancer in remission after only 8 days!!!!  Studies show that children who achieve remission in the first 7 to 14 days have an extremely good change of long-term survival.

Though this is amazing news that we took time to celebrate with a bottle of bubbly, we are staying vigilant for the next two to three years of treatment to KEEP her cancer free.

Carmen has now entered the Consolidation phase.  Without further therapy Carmen would quickly relapse.  The goal of the consolidation therapy is to continue killing the remaining leukemia cells and stop new disease cells from forming.  As long as her counts meet the protocol requirements, Carmen and mommy will be traveling to Oahu every week for the next three weeks for Carmen to receive LP's.  She will get intrathecal chemotherapy in her spinal fluid for her next three appointments which require her to be sedated.  By the way, Carmen's Oncologist never did find any cancer cells in her spinal fluid!!

This process is far trickier than it sounds because cancer cells, which by definition are very unstable, tend to mutate frequently and can become resistant to the drugs that initially kill them.  As a result, the consolidation phase consists of new combinations of drugs designed to destroy the cancer cells that survived the induction and stop the development of new cancer cells.

Putting all the scary medical "mumbo jumbo" aside for a minute we can all take this moment to celebrate this enormous achievement.   Our TLP is fighting hard everyday and she is hearing your prayers!!!

Today, Heather needed to take Carmen to Lihue for a blood test in preparation for her Chemotherapy therapy treatment on Tuesday.   Carmen's ANC and Hemoglobin came back terrific but her platelet counts were too low to receive the Chemotherapy Treatment.   Heather needed to change her flight to Honolulu to Wednesday and will need go for another blood test on Tuesday to ensure her counts are up.

I am happy to tell that you that our sweet little baby girl is starting to get back to her old self again.  The sound of her little voice and laughter is once again filling our home.  Gone are the cravings and returned is the appetite for fresh fruits and vegetables.  The juicer Heather introduced is a bit hit.  Carmen's mood is improving and her activity level and strength is slowing starting to return.

She is having a great time playing with Trevor and getting back into playing with her crafts and stickers.

Below are pictures from the last few days

Color Silly

Mmmmmm.......I am making juice!

Carmen's first Coconut in a month!

Tracing time!

Window Art

A little driving snack on the way to give blood this morning.