FEB 23, 2010: CASPER'S FIRST WEEK

Casper arrived at OHSU in good spirits. The rest of us were reeling a little, but he was chatting up all the nurses, and running around the halls. We were checked into the swanky, "suite" room, which was purely luck. It is designed to have a negative air flow for patients who can have no exposure to outside bacteria or something, but I guess there was no one in at the time requiring this treatment so we got the sweet party penthouse. As soon as she heard the news, Casper's Auntie Ellie came right up to the hospital where she added much needed moral support and spent the next few days running hundreds of errands for us. "Yia Yia" Ariel also arrived in from California late Tuesday night and spent the week helping us maintain a level of sanity and stability.

We were introduced to a couple of the doctors on our team, Dr. Russell, and Dr. Kurre, and the resident Joy Johnson. They were very warm and spent a lot of time in the room with us, going over what was going on, what news they did know, what news they didn't but would get for us, etc. They informed us that the biopsy showed pre-B leukemic cells within it. Leukemia does not usually present in this fashion with one isolated point of origin. As a result of this strange presentation, it appears that we were able to find the leukemia early before Casper became very ill or his bloodcounts were very abnormal, which was lucky. The fact that pre-B cells were found in the biopsy also indicated to the doctors that Casper had Acute Lymphoblastic Leukemia (ALL), rather than Acute Myaloidal Leukemia (AML). The treatment for ALL is generally less intensive, but has a longer duration. We were a little shocked to learn that treatment for boys lasts about three years, but thankfully most of this with any luck should be on an outpatient basis with a number of specific treatment phases over this course of time. Casper's age at diagnosis is also considered a very good prognostic factor. Generally children between the ages of 2 and 10 have the best long-term results.

Over these first days, Casper had a Bone Marrow Aspiration to find out how much of his marrow had cancerous cells, and a spinal tap to see if there was any cancer detected in the Central Nervous System (CNS). Again we were relieved to learn that at this point no cells were detected in the sample taken from the CNS, and there was only a moderate number of cells in the Bone Marrow. Chemotherapy will target both, as it's common for cancer to show up in the CNS if it's not preventetavely treated. The final test that was done during this initial week which is a relatively new addition to the treatment protocal was to test the actual genetics of the cancerous mutations. This is not to be confused with the DNA of Casper's healthy white cells. Researchers have come to discover that the existance of certain chromosomal patterns in the cancerous cells may indicate a higher or lower likelihood of success from standard chemotherapy treatment. The results took several days to come back, which was a little nervewracking, but I guess we need to get used to this. Casper's cancer was found to a triple trisomy chromsomal pattern that is likely to respond favorably to chemotherapy. So we've found one other positive thing to add to our little battle quiver!

Casper started the preliminary "Induction" phase of his treatment while we were in the hopital. This is a more intensive period where he's given a number of chemotherapy drugs, and a strong dose of steriods for 28 days. The goal during this month is to bring about a full remission by killing the cancer cells. A full remission generally means that after this 28 day period, no cancer cells can be found in a sample, but the understanding is that there are still some cells in his body, they just aren't detectable with the technology presently available.