Giuseppe came by and saw Marta and Isita yesterday afternoon. He explained the plan for the next stage of Isita’s treatment. Frustratingly, that plan involves more waiting. But we do, at least, know the direction. 

The most important decision is that surgery will not happen until after the high-dose chemotherapy. This is because of the risk that she will lose her right kidney as a result of the surgery. They want her to go into the high-dose chemo with both kidneys intact.

 Ideally, we would start the high dose immediately. We can’t do this because there are still traces of adenovirus in Isita’s blood so they can’t harvest her stem cells. She is no longer on anti-viral medication and despite this, the viral load tests show that the number of ‘copies’ in her blood is falling. A month and a half ago when she was most sick, there were several million per millilitre, then 100,000, a fortnight ago 10,000, last week 4,000, down to 3,000 back up to 3,500 and now 1,300. Soon we will be counting in hundreds. We are aiming for zero.

If the rate has fallen enough by next Tuesday, they will start gearing up for the stem cell harvest which takes a few days. A great indication that we are heading in the right direction is that Isita did a normal poo this morning. Sorry to be graphic, but amazingly we do mimic the crazy doctors in The Madness of King George III, peering into bedpans all the time and seeing if we can tell any difference. We have become students of the Bristol Scale.

 If the viral load has not fallen enough, Giuseppe has improvised a replacement therapy intended to maintain the benefits which the treatment has achieved to date, without creating additional side-effects which will set us back in other ways. He would start Isita on retinoid therapy. This is also known as differentiation therapy. It works by helping cancer cells mature into normal functional cells. 

Normally, it would be prescribed much later in the treatment and whatever happens Isita will go back to it later on. It is basically just a stop-gap to ensure that some treatment is going on as we get further away from the last date when chemotherapy was administered. The best thing for Isita will be if we can drive out the last traces of the virus as quickly as possible and get going with the stem cell harvest and high-dose chemotherapy.