Delayed Intensification Overview

We are coming to the end of the Interim Maintenance phase of treatment and we have really enjoyed the break. Starting next week the Delayed Intensification (DI) phase will begin. Ben has already received most of the drugs in earlier phases of his treatment so we are familiar with the side effects but there are a couple of new ones.

The schedule will be as follows:

Dexamethasone (by pill) days 1-21. This is the steroid Ben has taken in the previous phases so we expect him to get his round face and belly again. Unfortunately, this drug is the toughest on him emotionally because it causes huge mood swings. He goes from being happy to angry to sad in the matter of seconds. It is pretty difficult for him.

Vincristine (via PICC line) days 1, 8 and 15. This drug is pretty tough on his tummy but thankfully they give him Zofran to combat this so it is usually pretty mild.

Doxorubicin (via PICC line) days 1, 8 and 15. This is a new drug. Doxorubicin is a type of antibiotic that is only used in cancer chemotherapy. It slows or stops the growth of cancer cells in your body. Common side effects include low blood counts, nausea and hair loss. We will find out next week how Ben will react.

PEG Asparaginase (via needle in leg muscle) day 6. This is what we refer to as the dreaded leg injections. Of all the medications this is the one that keeps Ben awake at night with worry.

Cyclophosphamide (via PICC line) day 29. This is the mustard gas derivative that Scott described a few months ago. They need to give lots of hydration before and after (about 6-8 hours worth) to protect his kidneys so this will be a long day at the hospital, but thankfully doesn't cause Ben any discomfort.

Thioguanine (by pill) days 29-42. This is a new drug. Thioguanine belongs to a class of medications known as antimetabolites. It resembles a normal cell nutrient needed by cancer cells to grow. The cancer cells take up thioguanine, which then interferes with their growth. Common side effects are low blood counts and nausea.

Cytarabine (aka ARA-C) (via PICC line) days 29-32 and 36-39. Ben doesn't mind this because it just means we hang out at the Infusion Center for a few hours...although the fact that we will need to do this on Thanksgiving is not so great! This (and the cyclophosphamide) are the ones that really impacted his blood counts over the summer and caused the daily trips to the hospital for prophylactic antibiotics.

Methotrexate (via spinal tap) days 1 and 29. Ben is a pro at these now so shouldn't be a problem.

We are hoping that there won't be any big blood count drops at the beginning of this phase so Ben can continue to go to school for a little longer but we will wait and see. The PICC line will be put back in next week so at least blood draws will not cause him any pain.