We just finished our last day of Standard interim maintenance therapy(SIMT) yesterday! the normal procedure for SIMT which involved Gage having to go through this:

• vincristine IV on days 1 and 29
• dexamethasone IV or orally twice daily on days 1-5 and 29-33
• oral 6MP on days 1-50
• oral methotrexate on days 1, 8, 15, 22, 29, 36, 43, and 50
• methotrexate IT on day 29

The IT the methotrexate mentions on day 29 means InTrathecal, basically they injected it into his spinal fluid, via lumbar puncture. Always a good time at chemo.

It is so good to know that we only have one more therapy session before we continue on to Standard delayed intensification therapy, and that’s only if Gages blood count is high enough to move on. Which from past experiences I know that treatment can be delayed for weeks on end.

This is what Standard delayed intensification therapy consists of:

• vincristine IV on days 1, 8, and 15
• dexamethasone IV or orally twice daily on days 1-21
• doxorubicin IV over 15 minutes to 2 hours on days 1, 8, and 15
• pegaspargase IM on day 4, 5, or 6
• cyclophosphamide IV over 30 minutes on day 29
• cytarabine IV or subcutaneously (SC) on days 29-32 and 36-39
• oral thioguanine on days 29-42
• methotrexate IT on days 1 and 29

This round of therapy is similar to the consolidation therapy, he went through in the very beginning but Gage was in the hospital, having everything go wrong with him, we were more worried about him surviving complications to surgeries and infections. I honest to Jeebus can’t remember any part of consolidation therapy, also mid way through treatment Gages diagnoses was changed from aggressive treatment to standard treatment; due to complications from his pegaspargase. That complication was one of the best complications so far, just because they were able to reevaluate him and judge he was responding so well to treatment so his chemo doses were decreased and so now they aren’t as strong.

Once Gage is done with Standard delayed intensification therapy, he will move onto Maintenance therapy, for the next three and a half years. Which seems like such a long time, but three years is nothing since we want Gage here for at least another eighty years or so. This is what Maintenance therapy involves:

Each course of maintenance proceeds as outlined below. Courses repeat every 84 days for a total of 2 years from the start of interim maintenance therapy for female patients and 3 years from the start of interim maintenance therapy for male patients.

• vincristine IV on days 1, 29, and 57
• oral dexamethasone twice daily on days 1-5, 29-33, and 57-61
• oral methotrexate on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78
• oral mercaptopurine on days 1-84
• methotrexate IT on day 1

It just seems incredible to me that Gage, has undergone such dangerous treatments. Seriously, I have to inject these things into him on a daily basis, and yet I can’t even throw them in the trash because it is hazardous waste and totally illegal. But if this saves his life, then I am willing to do anything.

Gage getting his dressing cleaned and changed. He is so awesome! Oh, and yes, that tube is sticking out of his chest, it actually coils into his heart.