Diagnosis: Acute Myeloid Leukemia (AML). A Journey

We started this week off with a trip to the cardiologist to get an EKG and a chest x-ray for George. There was still some concern about the fluid/edema in his feel, ankles and calves. The doctor wanted to make sure there wasn’t any fluid around his heart. He got the all-clear from that visit, so that was a relief!

Today, Friday Aug 4th, George had his 8th bone marrow biopsy. He really is becoming an old pro at this! His appointment was at 8:00 and we were to arrive at 7:30. We checked in at radiology and were taken back fairly quickly.

As I mentioned in my previous post, the results of this biopsy are important because George’s marrow must be clear of leukemia cells in order to proceed with his second bone marrow transplant. We should have initial results in the next 3 days or so. Then he has an appointment with Dr. Loren on the 9th to go over the results and plan the next step.

Actually, what we are hoping will be the next step is already under way. Rachel, the bone marrow transplant coordinator called earlier this week and told George he has a hospital admission date of August 23rd, of course pending the results of the biopsy. It will be just like last time…they will call us when his bed is available and we can go in any time after that. He will be back on the 14th floor at the Pavilion at HUP (Hospital at the University of Pennsylvania). Everything has already been coordinated with the donor. We are SO grateful once again. She asked us if we needed to attend the online transplant prep class and we said nope. Been there, done all that! I know what to pack for the hospital, what to cook and how to keep my house clean! I know how to keep George safe when he comes home.

This time he will undergo 4 days of chemo and then have 2 days of rest. No radiation. On August 30th, he will have his second re-birthday and receive his new donor cells. So now, we just play the waiting game first for the biopsy results, and then for hospital admission day.

Weird Genes….

Meanwhile, earlier this week, George got the chromosome analysis from his last bone marrow biopsy. It takes about 4 weeks to get the molecular data back. We already knew he had a partial deletion of the long arm of his 7th chromosome. But now, there’s even more weird stuff going on….

Translocation means that basically part of one chromosome changes places with another. Officially, a translocation, as related to genetics, occurs when a chromosome breaks and the (typically two) fragmented pieces re-attach to different chromosomes. So, the first item I have underlined is telling us that part of his 2nd chromosome has changed places with part of his 8th!

Then on his 12th chromosome, there’s some unknown chromosomal material replacing part of his 12th chromosome (no idea where it came from)!! And finally, parts of his 16th and 19th chromosomes have translocated/ switched places!

This is so bizarre! We will have to ask Dr. Loren what the significance of this new information is! I did read that chromosomal translocations are one of the most common types of genetic rearrangements and are molecular signatures for many types of cancers. They are considered as primary causes for cancers, especially lymphoma and leukemia. OY.

Also, just from the research I’ve been doing, I think the term “clonal evolution’ is significant and I want to ask Dr. Loren what it means, but I don’t want to ask in front of George. UGH. He said he doesn’t do any research himself so he doesn’t see anything that “might freak me out.” I get it, George!

That’s all for now. We are just anxiously awaiting the results from the biopsy so we can know if we are proceeding with transplant. Tune in next time!