Yesterday, I had to go back up to the Royal Marsden for blood tests and my PICC line to be flushed and the dressing changed, another bone marrow aspirate and, I thought, the beginning of my consolidation phase. Bloods were soo much easier now I have the PICC line in! No stabbing necessary! And the bone marrow aspirate wasn't bad at all as I had lovely sedation again! Only problem was my neutrophil count had dropped again to 0.52, so they weren't happy to give me the intrathecal chemo they were planning on doing, so I haven't started my consolidation phase yet. They want my neutrophil count to be above 0.75 and platelets above 75 (which they are) before they start that phase, so bit of a waiting game now!
I did receive the news, however, that they had received the results for the minimal residual disease test on my bone marrow from Barts. Now, a 'quick' explanation as to what this is:
Minimal
Residual Disease (known as MRD) is a post-treatment condition
associated with cancer, specifically leukemia. The condition refers to small
numbers of cancerous cells remaining in the body’s tissues, and not being
eradicated by treatment. It can occur in patients part way through treatment
and also in patients thought to be in remission (meaning that they show no
signs of cancer post-treatment). MRD is the most significant cause of
relapse in cancer patients following chemotherapy treatment.
How
was MRD discovered?
Several
decades ago when leukemia was first treated, many patients would appear to
respond well. Chemotherapy would be administered in much shorter sessions than
is the case now, for weeks rather than months. But it was effective in
destroying most abnormal, cancerous cells. The patient would go into
“remission” showing no signs of disease. However, patients would be left with a
tiny number of cancerous cells and after a few weeks or months, symptoms would
reappear and patients would relapse.
Tests were conducted on cells affected by the cancer (usually in the bone marrow) following treatment to try to confirm that the cells were normal. Unfortunately, these tests relied upon microscopes and when leukemic cells are viewed in this way, it is impossible to tell them apart from normal immature white blood cells. Therefore, leukemic cells regrew and the patient relapsed.
Through genetic testing, scientists determined that leukemic cells found in relapsing patients were descended from the same cancerous cells which first brought about the disease. So, the name Minimal Residual Disease was given to indicate that the condition is caused by minimal numbers of remaining, or residual, cancerous cells in the body.
How
has technology helped the fight against MRD?
With
recent advances in scientific knowledge and medical technology, it is now
possible to conduct much more accurate tests to detect residual cancer cells
after treatment. Even a single leukemic cell in one million normal cells can
cause a relapse as cancer cells multiply uncontrollably. So tests with this
level of accuracy result in a greatly reduced risk of relapse following
chemotherapy and consequently a far greater rate of survival. Whilst most
research into MRD has been with leukemia patients, it is hoped that other
cancer treatments may also benefit.
How
significant is MRD testing in fighting leukemia?
MRD is
the main cause of relapse in leukemia patients, but testing for this condition
has become an important part of establishing a more accurate prognosis and
fighting the cancer itself.
It
was found that if a patient’s blood or bone marrow were tested at certain
stages after treatment, MRD test results could indicate how well they were
recovering and determine how likely they were to relapse. Patients with less
than one leukemic cell in 100,000 had a very slight risk of relapse, whereas
those with one leukemic cell in 1,000 had a very high risk factor.
Whilst this may seem obvious, it has opened up
the opportunity to provide those patients who are at high risk of relapse with
alternative treatments, hoping to reduce the risk. It has also proved helpful
in the very early detection of recurring leukemia in patients several years
after an initial attack.
Now, unfortunately, although my initial results showed
that I have no leukaemia cells and that I technically am in remission, my MRD
results have come back as positive. So, there are very minute amounts of
leukaemia cells still hanging around my bone marrow. Now, although this
means I have an increased chance of relapsing, it more importantly means that
the treatment I get is reassessed so I get a more intense consolidation phase
to make sure we knock all those little bastard leukaemia cells out!
Whereas before the consolidation phase was going to be 5 weeks of the treatment
I had explained in my last blog, it is now going to be 9-10 weeks of a very
similar protocol but with more Vincristine and Pegaspargase thrown in for
good measure essentially!
Although this isn't the best news I was hoping for, it is simply another hurdle, which we knew could happen. On the plus side - I'm home again for the weekend! And I get to see my lovely Auntie Boo on Sunday! Monday does involve having to go up to the Royal Marsden for more blood tests again, however, and for a chat with the consultant, but I think I can manage that!
Hope you all have a lovely weekend too! Much love
to you all xxx
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