Bonnie reports on the latest decision in Don's leukemia battle:

We met with Don’s Fred Hutch oncologist today. We thought the meeting would be about making a decision between continuing with more cycles of chemo (he has done 4 out of 8) or going in a new direction with a POMP regimen(usually reserved for patients AFTER they have completed chemo.)  

We told the doctor that though chemo has been so rough for Don we are used to fighting our way through adversity. Our first child Ryan died of SIDS; our second son Scott got cancer when he was going into college; I was in the hospital for two months in premature labor with our third son Kyle; and he spent a long time in the Neonatal ICU. We have had heavy things in our life and we have overcome them, and we feel that we can overcome this. 

I also told her that we were hard workers and if we have a job we can do it. Don and I are a team that works together. 

Our doctor listened patiently, then told us that after consulting with the doctor who had devised the chemo regimen Don was on, she and the Fred Hutch team believe we should not go back to chemo. We may be fighters, but we don’t want chemo to kill Don. He has suffered the side effects of having fluid retention, alarmingly low blood pressure, arrhythmia, kidney malfunction, neurological disorders, fungal infection, extreme fatigue, not being able to walk, and more. The effects of chemo are cumulative, and she fears that more chemo could be very dangerous. Because of all these side effects, they have reduced the chemo dosage so much that she also questions its effectiveness.  

 So what is POMP? It is a two-year program patients graduate to after they have completed chemo.

P – Purinethol (Mercaptopurine)
O – Oncovin® (Vincristine)
M – Methotrexate
P – Prednisone

How is POMP maintenance therapy for Lymphoma taken?

• Vincristine intravenous (I.V.) infusion given over 15 minutes once monthly
• Methotrexate oral tablets by mouth once weekly
• Mercaptopurine 50 mg oral tablet by mouth three times a day (at least one hour after evening meal) every day
• Prednisone 200 mg (four 50 mg tablets) by mouth once daily for 5 consecutive days once per month

The advantages of POMP:

·         No more UW overnight hospital visits 

·         No more bone-crushing chemo

·         Fewer Fred Hutch visits

·         Two of the drugs are new to Don and may provide more protection than a diluted dose of chemo drugs

·         Blood counts (neutrophils) will not go so low as when chemo killed everything, so Don is not at as great of risk of infection, which means more freedom socially

·         In short, the less intense POMP will lead to a greater quality of life. 

The disadvantages of POMP:

·         We are not completing the recommended 8 chemo cycles which would give Don a greater chance of remission;

·         We may be trading quantity of life for quality of life;

·         There are no statistics on the outcomes for patients who have not completed all chemo cycles, so the future is more uncertain.  

How do we feel?
In a sense, it feels like giving up. The doctor asked if we wanted to go home and discuss our decision, but we said we are not in the position to question these experienced health care professionals. (Similar to when people said they had “done their research” and weren’t going to get the Covid vaccine.) We are in no position to do research, and we trust the science and advice of health care professionals who know what they are doing. Treating this disease is an inexact science, but we will work with our Fred Hutch Team to beat this. 

On the other hand, we will be happy to have a less grueling schedule and live a more “normal” life. We hope we can start to take a few little short trips, and we will have the time and energy to visit our friends and play with our granddaughters.
No one knows what the future will bring -- so please help us celebrate the present.