The Diagnosis
Andrei was diagnosed with Acute Lymphoblastic Leukemia (ALL) in September 2010, just after his 49th birthday. ALL is a type of blood cancer. The malignant cells of Acute Lymphoblastic Leukemia are lymphoid precursor cells (i.e., lymphoblasts) that are arrested in an early stage of development. This arrest is caused by an abnormal expression of genes, often as a result of chromosomal translocations. The lymphoblasts replace the normal marrow elements, resulting in a decrease in the production of normal blood cells. Consequently, anemia (deficiency of red blood cells), thrombocytopenia (deficiency of platelets), and neutropenia (deficiency of white blood cells or neutrophils) occur to varying degrees. The lymphoblasts also proliferate in organs other than the marrow, particularly the liver, spleen, and lymph nodes.
Acute lymphoblastic leukemia (ALL) is the most common type of leukemia in children in the United States. Approximately 1000 new cases of ALL occur in adults each year. However, due to the fact that there are more adults than children, the number of cases seen in adults is comparable to that seen in children. The upside is that kids respond really well to treatment and often achieve lifelong remission. The downside is that it is extremely aggressive in adults, and if left untreated can be deadly in a matter of weeks.
Worldwide, the highest incidence of ALL occurs in Italy, the United States, Switzerland, and Costa Rica, and this disease is slightly more common in men than women.
After he was diagnosed with ALL in the fall of 2010, Andre went through a grueling 6-month Hyper-CVAD chemo treatment, responded very well to the treatment, and achieved complete remission since November 2010. However, in May of 2011, a follow-up biopsy revealed a small presense of leukemic blasts in his bone marrow, generally referred to as Minimum Residual Desease. Studies indicate that MRD positivity can be a strong sign of an impending relapse. The only hope for a long-term cure at that point was a bone marrow transplant.
A donor search undertaken by Seattle Cancer Care Alliance found not one but two 100% match donors. Better news couldn’t be had, especially since his only brother was 9/10 match and was located half way around the world in Siberia. Our biggest challenge (we thought) was going to be finding housing in Seattle and raising the necessary funds for said housing. We went to Seattle and spent a day checking options. We held a three-prong fund-raiser.
What we didn’t expect was the overwhelming aggressiveness of the disease and how resistant it had become to chemotherapy. Andrei’s last bone marrow biopsy showed nearly 80% cancer cells (he originally presented with about 40-50%). The treatment options were few, but he was determined to try. The docs decided to try another round of Hyper-CVAD, but that seemed ineffective. The following week a new protocol was introduced, called MOAD, which utilized a new drug, pegasparigenase. Success seemed at hand when his blast counts dropped and the cancer seemed to be responding.
Andrei managed to bust loose from the hospital just before our big fund raiser on July 31 (at which he had an amazing and touching time), but three days later with white counts so low they were unreadable, he got a fever and had go back into the hospital. Sadly, he never came home. Sepsis and pancytopenia, a condition in which the bone marrow can’t make any cells, coupled with cancer progressions, got the best of him although he fought till the very end.
Since then, I have struggled to better understand Andrei’s ordeal and truly be grateful for the too-short of a time we had together. This blog is part of that labor of love, and Andrei’s diagnosis and experience can hopefully help others who face the same disease.
