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On a COG Clinical Trial. Hey greeney, Yes that's her protocol. And she classified as HR because her WBC count at diagnosis was way beyond 10,000. Thanks for all the information. We're on day 2 of induction. Just started our tough journey 🙁 PS: Are you the greeney for the LLS Forum 😀
And got the following answer:
Is it (COG AAML0631) Risk Adapted Treatment of Newly Diagnosed Childhood Acute Promyelocytic Leukemia (APL) using Arsenic Trioxide (Trisenox IND# 103,331) During Consolidation? Has your daughter been classified HR (high risk) or SR (standard risk) and was her WBC higher or lower than ten? APL is characterized by a severe coagulopathy subtype, this can cause complications during Induction (1st phase) such as cranial hemorrhage. It's such a heavy duty treatment protocol, to my knowledge Induction seems to have the highest risk of complications especially if it is coagulopathy-related. With our daughter (difference being ALL) we found Induction the hardest & delayed intensification. The consolidation phases in this treatment will be fairly hard going as well, there will be bouts of mucusitis due to this protocol no matter how hard you try to keep her mouth clean, there are various meds to help with this, there will be the inevitable neutropenic fevers, also fevers that indicate infection but cultures will come back negative they are mysterious fevers and cause is never known, it just happens, when cultures come back positive IV antibio/antifungals are given, many times antibiotics are given before cultures are determined as a precautionary measure, especially when neutropenic as infection can cause a toxic shower through the body and is nearly impossible to control, thats the main reason many kids sucumb to this hideous disease. It's important to relay any changes you may notice in your child to the Onc for investigation, remember when in doubt about something have it checked out, it's a matter of life. After you complete frontline Induction & consolidation Phases maintenance for the next couple of years is a walk in the park in comparison but you still live on the edge while they are on treatment. So sorry you have to do this xx The Primary Objective to this new trial To decrease the total anthracycline dose from the best current published results in patients with standard-risk childhood acute promyelocytic leukemia (APL) while still maintaining a comparable event-free survival (EFS). COG-AAML0631 (Combination Chemotherapy in Treating Young Patients With Newly Diagnosed APL): The Children's Oncology Group is conducting this study evaluating the addition of two courses of arsenic trioxide plus ATRA to a backbone treatment regimen based on the Italian AIDA treatment regimen, but with modifications to reduce the cumulative doses of anthracyclines. The primary objective is to decrease the total anthracycline dose from that used in regimens with the best current published results while still maintaining a comparable EFS. Promising results from pilot studies using arsenic trioxide and ATRA in newly diagnosed patients with APL also support evaluation of this combination. A little info on Anthracyclines: The anthracyclines, particularly doxorubicin (generic name Adriamycin), are known to cause heart failure in a subset of patients in a dose-dependent manner. In other words, the higher the cumulative dose, the larger number of patients who experience this effect. Anthracycline-induced cardiotoxicity appears to have two phases: an acute phase, in which symptoms develop during treatment, but are transient; and a late phase, in which cardiac damage progresses over time, eventually presenting as congestive heart failure as early as a year after treatment and up to a decade or more after treatment (Brouwer, et al). Late congestive heart failure can develop even in the absence of acute symptoms during treatment, and with the exception of broad guidelines (age, pre-existing cardiovascular conditions), there is no means of identifying at-risk patients. As described above, efforts to prevent cardiotoxicity through antioxidant or iron chelator pre-treatment have proven ineffective or, if effective against cardiotoxicity, also reduced anti-tumor action. APL is pretty rare therefore not many know how tough the treatment is but I liken the frontline treatment to AML and the maintenance therapy to ALL, AML frontline is very challenging.