Consolidation Chemotherapy & Associated Events
Dad’s consolidation course started pretty quickly after his induction course. Here is a brief timeline of major events during this time which encompasses about 6 months.
Home after induction chemotherapy — 1 week
First consolidation chemotherapy — 6 days in the hospital
Home for 6 days
Admission for septic shock — 8 days in the hospital
Home for 22 days
Second consolidation chemotherapy — 6 days in the hospital
Home for 8 days
Admission for neutropenic fever — 8 days in the hospital
Home recovery — 3 months
Stem cell transplant delayed due to fatigue and weight loss
Had good recovery of counts but then slow down trend of his platelets and ANC with a relatively stable hemoglobin over about 2 months
Relapse
This time was different from induction chemotherapy, as opposed to a month of dedicated inpatient time, there were multiple hospital admissions and multiple (sometimes sequential) trips to the emergency room — which lent itself to a number of different stresses — in addition to a myriad of signs and symptoms that were separate from those that he had during his induction chemotherapy and that were very foreign to my previously, very healthy vegan Dad. Even still, Dad maintained a high level of optimism and gratitude during this entire time.
This graph shows Dad’s labs and overall state from the start of consolidation all the way to when he relapsed. Each hash mark on the bottom is one day. There’s a few things we can talk about here which I will address below in summary; a more in-depth report and day-by-day notes for each time period can be found in the coming pages.
Consolidation chemotherapy rounds #1 and #2
The chemotherapy was different than induction. As opposed to the constant 7 days of cytarabine and 3 days of intermittent idarubicin during induction, Dad received HIDAC which is high dose cytarabine; 3 doses were given every other day and he was discharged each time the day after the last dose. He received two rounds of consolidation chemotherapy because we were preparing for a stem cell transplant after the second round. However, because of how tired all the chemo and sequelae from the chemo made my Dad, he decided to wait on the transplant and see if he could recover well without the transplant.
WBC trends after consolidation
The first obvious thing is that each episode of consolidation dropped Dad’s WBC down to 0.1; this usually happened around 10 days after the start of each chemotherapy cycle and his ANC was 0 during this time. It stayed this way usually for approximately 5-7 days and then his WBC would come back up. During both times, Dad had to go back to the hospital during this time — for septic shock secondary to bacteremia (bacteria in the blood) after his first consolidation and for an unexplained neutropenic fever (with headache, abdominal pain, and chills) after his second consolidation.
Overall state
Dad’s overall state fluctuated relatively in tune with his hemoglobin; after each instance of consolidation chemotherapy, this readily downtrended and he required blood transfusions both times.
Septic shock
About 6 days after discharge after his first consolidation chemotherapy, Dad had a fever of 101 degrees. He didn’t think too much of it and went to sleep. The fever persisted into the morning and he went to the hospital and was found to be septic with bacteria in his blood. He was diagnosed with septic shock — as he needed blood pressure increasing medications to maintain his low blood pressures — and was admitted to the ICU. Thankfully, he was downgraded from the ICU after two days. He dealt with anal pain and bowel urgency during this time.
Neutropenic fever
After his second consolidation, Dad had a neutropenic fever of 102.8; after our first bout of septic shock, there was no delay in getting him to the hospital. He was treated with IV antibiotics for 2 days before the high fevers went away but still had low grade fevers that started again towards the end of his hospital stay. His hospital internal medicine doctor thought it was fine to discharge him so he went home; he continued to have temperatures of 100.7 to 101.3 without any other significant symptoms which stopped about 8 days after discharge. We never found out what was causing them.
Road to relapse
After he came home from his bout with his neutropenic fever, Dad did very well. He gained his weight back to where he was before he got sick and he was walking and functioning back to his normal baseline; he felt nearly back to normal. About a month after he came home, however, we started to notice that his WBC, ANC, and platelets were starting to slowly descend. His oncologist did not find the labs concerning. Two months later, we got a call from the oncologist letting us know that there were blasts in the blood, causing a spike in his WBC, and Dad was diagnosed with a relapse.