[Greg H]

On Tuesday, I had a phone call from Dr. Horwitz explaining why it makes more sense to begin induction chemotherapy — as though we were treating Acute Myeloid Leukemia [AML] rather than high-risk MDS -- as opposed to trying to continue on Vidaza.

He explained that he and Dr. DeCastro believe that all these fevers I have been having (every afternoon for the past four days), are not the result of some infection, but the result of the disease itself. Ditto the migraines, the knee pain, and the episode of stabbing pain in my eye.

My counts are terribly low. My white blood cells are three tenths of a point from zero. My platelets are trending down every day, approaching 10, where you have to have a transfusion or risk bleeding out. These are the kinds of counts you get with the conditioning chemo for a transplant. And they make it unlikely that I could return home to resume Vidaza over at Levine Cancer Center in Albemarle.

So, we are going to Plan B, which we had discussed in our initial visit with Dr. Horwitz. I had a two lumen Hickman catheter implanted in my chest yesterday and last night at about 10 pm we began the first day of seven days of serious chemotherapy using cytotoxic drugs.

I’ll have seven days of continuous Cytarabine. The first three days I will also have Idarubicin.

These will make my hair fall out, though my beard may not.

The drugs will suppress all my counts. The idea is to clean out the bad stuff in my marrow, and have the remnant regrow a new blood production system.

After the therapy, Marcy and I will need to stay 3-4 more weeks in the hospital, waiting for that regrowth. After that, we may be able to stay at home for a week or so, until they are ready to do the transplant.

Normally, in AML therapy, after a few weeks, you have another smaller dose of 2-4 chemo drugs. It’s called consolidation. But, in this case, we will move transplant instead. The goal there, of course, will be to transplant my existing blood production system — which we know is kind of junk, because of the TERT mutation and short telomeres — with a new one.

So, this will mean a longer stay in Durham for Marcy and me.

But it seems like the most reasonable course of action given my counts.

Dr. Horwitz and I have not discussed the transplant regimen, which I reckon will be highly dependent on how well I have responded to the induction chemotherapy.

So, it's needles. And I am good with that.