Decitabine: Hypomethylating Agent

            We saw Dr. Fathi yesterday. David asked him: since the decitabine seems to be effective, would he have chosen it as the initial treatment. He said no: the 7-3 cytarabine/daunorubicin regimen that David started nearly a year ago at Walter Reed is the standard first-line treatment for someone of David’s age with AML (acute myeloid leukemia). Over the whole population it has a remission rate of about 70%. And David did achieve remission from it, it just relapsed. Decitabine therapy has a remission rate of 40% or less. So, based on statistics, which is all we have to go on, the treatment choice was reasonable. Of course, for each individual patient, the remission rate is either zero or 100 percent.

            The current decitabine infusion therapy isn’t technically chemotherapy. At high doses, decitabine can be used as chemotherapy, with the goal of killing leukemic cells (and healthy blood, hair, and gut cells as collateral damage). But at this lower dose, it’s a “hypomethylating agent”. The theory is that the decitabine can reactivate tumor suppression genes in individual cells (cool, huh?) and thus allow the leukemic blasts to mature into healthy cells.

For five days, February 23 through 27, we went to Cox 1 each day for the fourth round of decitabine infusion therapy. The next bone marrow biopsy, probably in about three weeks, will indicate how well the decitabine is working. It will also show the status of the various mutations involved. The bone marrow has its own ecology, like a garden. David has multiple mutations of his white blood cells, like a garden with a variety of weeds. If you pull out one type of weed, there’s the danger that another, existing weed will invade the newly cleared area. Unfortunately, we don’t know how to pull out all the weeds at the same time or speed the spread of beneficial plants.

And speaking of gardens, today we had a thaw: 40 degree weather and puddles in our driveway. Still plenty of snow, but in March there’s always hope of spring.

Last week we had some excitement. My idyllic afternoon dishwashing was interrupted by a sudden crash and breaking glass. My first thought was that a giant icicle (we have several) had hit our bay window. But the staircase landing was full of glass and snow, no ice. Looking through the shattered window, we saw a 12 foot piece of our gutter forming an upside-down V in a snowbank. Roof snow had melted and refrozen into a heavy ice dam on top of the gutter. The ice was probably a few hundred pounds. The weight had broken the gutter in two and sent one piece careening to the ground, bashing the window on its descent. The remaining partial gutter, also full of heavy ice, hung directly over the power line to our house. A contractor friend came to the rescue and successfully removed the gutter. He also gave us some insulating foam board to cover the window until we can get it repaired. Was someone talking about gardens?