Monday, 18 January 2010

It all changes so quickly...

So yesterday morning I started off with no symptoms, no temperature, nothing. By 7pm, I had developed a headache, a minor cough and a pain in my lower stomach accompanied by a temperature of 38.4.

As I've written before, as soon as you hit a temperature of above 38 a standard protocol kicks in. That is:

1. Blood is extracted from both lumens of the PICC line and cultured to check them for infection
2. Blood is extracted from the periphery blood and cultured to compare them against the blood in the PICC line and identify known infections
3. The Doctor is called
4. You are invariably immediately put on two IV antibiotics
5. A chest X-ray is scheduled

So by 11pm last night, I was on two new antibiotics. Paracetamol brought the temp down and helped the headache and the expectation is that the antibiotics kick in pretty quickly.

At 3am though I woke up cold and shivering. Flashbacks to the allergic reaction I suffered with a previous set of antibiotics set in, but this was different. I was only shivering when I was out of the bed; when I was buried in the bed clothes I felt cold but the shivering was minor. Called the nurse, and she gave me two extra blankets and a hot chocolate (best medicine!) which warmed me up ok and stopped the shivering.

Slept through the night and this morning feel better. The headache has gone, temperature is down to 37.4. Still have a pain in my lower stomach which if anything is slightly worse than yesterday but hoping this disappears today too.

One of the antibiotics was repeated this morning and I'll get it 2 more times today; the other antibiotic is an IV drip which I will get nightly.

Also today I am expecting to receive Mylotarg. Mylotarg is a new experimental drug that works in a different way to normal chemo. Normal chemo just blats any fast differentiating cell which is why it knocks out your immune system and your hair. In comparison, Mylotarg is a highly toxic cell killing drug combined with a antigen that binds with a protein called CD33 which is theoretically found only on leukemia cells. Therefore it delivers a bomb to leukemia cells and kills them by disrupting their DNA. Cool huh? Of course, the down side is that it's new, experimental and there is an argument that it is not as specific as it claims. Specifically, it is known to also target liver cells which can lead to liver problems in extreme circumstances.

Most of our knowledge of Mylotarg comes from a trial from Birmingham university called AML-15 which was started around July 2007 and closed around April 2009. AML-15 randomised AML suffers into receiving Mylotarg during induction chemo (first/second round of chemo), consolidation chemo (third/fourth round of chemo) or not at all. Only preliminary results from the induction arm are available but showed that there was reduced relapse of AML leukemia in patients who took Mylotarg (37%) vs those who did not (52%) after 3 years. More importantly, there was a significantly greater proportion of deaths through chemo in the Mylotarg arm. This suggests that Mylotarg significantly reduced relapse without increased toxicity. The success of Mylotarg has meant that in the current AML trial being run in the NHS (AML-17), Mylotarg will be given to 80% of patients within the trial.

So am planning to get Mylotarg today at 3mg/m2 concentration (the lowest level tested, but the same level in AML-15). Am a little nervous of the risks - quite a lot of people get reactions afterwards like fever, shaking (used to these though!), and of course there is the liver risk to worry about too. But worry doesn't server much purpose and I would be more kicking myself if in the future I had a relapse and I hadn't tried Mylotarg - I would always be thinking 'would it have made a difference?!'

That's all for now - hope everybody is well and will write later re infection + how the Mylotarg administration went.


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