One of the first things you get in treatment is the ever present RoadMap. With our hospital, since it was a teaching hospital, they essentially did a coinflip to see what path Skeeter’s treatment would take because they have three different medical trials running at one time. We didn’t have a choice in the path nor did we have an option to not be part of a clinical trial and from what I have learned, this is the standard at all major hospitals (and that is where you want to be for such treatments anyway).
The fact that they track and record every child’s recovery is important and a wonderful way to do it. We opted out of some of the secondary studies – especially one that would require a second bone marrow aspiration each time he got one, mainly because I couldn’t stand to put a 2 year old though that twice in a row. But everything else was done in twos – two blood samples, two spinal samples… so that one was used to for his treatment and counts and the other was used as research.
The current standard treatment plan is called Children’s Oncology Study (COG) 1991 and for girls lasts 2 years and 2 months and for boys is 3 years and 2 months (provided there isn’t anything that sets the schedule back and there usually is something). The COG-1991 research study is named after the year it started and the data has been rolling in since then. It is being done because the older way of treating kids was not preventing relapses so these experimental routes were being tested to improve the standard treatment. We were given a 30 page document with the study information, drugs and possible side effects and the treatment road map.
The COG-1991 is the best plan out there right now for ALL. It is what is making the long term survival rates as high as they are – the hard part is that they have no real knowledge of the long term effects of this plan since the first children that were on it are only now in their early 20s.
We ended up on the standard treatment arm of the study and this was our schedule.
- Induction (1 month): Trying to force primary remission and kill as many abnormal cells in the shortest time possible – combination of three or four drugs via different methods are used.
- Consolidation (1 month): New combination of drugs to destroy any cancer cells that survived Induction.
- Interim Maintenance 1 (7 weeks): Lower dose chemo span to give the body a rest.
- Delayed Intensification (7 weeks): A secondary Induction phase to help kill remaining cancer cells that may have risen in number during Interim Maintenance.
- Interim Maintenance 2 (7 weeks): A small Consolidation and rest phase after the Delayed Intensification.
- Maintenance (until total treatment time runs at least 3 years and 2 months in boys): Lower doses that are less toxic and easier to tolerate for the long term killing of leukemia cells.
