Denise Sproul

I only met her because I was a Facebook friend of her husband, R.C. Sproul, Jr., whom I know simply through a network of friends. Denise died today from relapsed AML (Acute Myeloid Leukemia). That’s the more aggressive version of what Beth has/had (sort of). Same family of leukemias. She had been hoping to receive a second bone marrow transplant, but that never came about.

Blessed are they that die in the Lord.

She was diagnosed in February 2011.

What’s the greatest danger? (Part 1)

My son John asked me this morning, “what’s the greatest danger that Mom is facing?” That’s a pretty good question, and here is my answer.

The first and greatest danger she faces is the leukemia itself. Mom’s bone marrow is damaged. Given that her damaged bone marrow is producing damaged cells, this is the root problem.

In all of us, our bone marrow produces “baby blood cells” called “blasts”, which then differentiate into the other types of blood cells: red cells, white cells (there are various types of white cells), and platelets.

However, Mom’s damaged marrow produces “blasts” that are damaged within their genes. These genetic damages, or defects, then become reproduced, and the primary symptom of this leukemia is to produce an overabundance of “blasts” which build up in the blood and bone marrow. If enough blasts build up, you get what’s called AML, or “acute myeloid leukemia”. This is the disease they first thought Mom had – with 20% “blasts” in the bone marrow, Mom would have been diagnosed with this.

And one of her earlier pathology reports came back saying “acute myeloid leukemia is indicated”. This is sort of a catch-all category of leukemias, with many sub-classes. Mom’s particular subclass is CMML, or “chronic myelomonocytic leukemia” which is characterized by the excess “blasts” in the bone marrow and blood, but it has its own characteristics as well.

AML may be described as “blasts gone wild” – they simply over-run the blood and marrow and overwhelm the person’s system, causing death.

One key danger is that Mom’s CMML will morph into the more aggressive form of AML. But the CMML, as is, is sufficient to kill her within an average of 12-24 months.

And we’re seeing a little bit of that happen right now. While the disease is being “controlled” with the Vidaza, we see that her blood levels continue to fall, generally (though some of them tend to moderate). But in all, her red blood cells have never moderated at all – they simply continue to fall all the time. And without the many transfusions she’s had, she’d drift off into severe anemia, and eventually, it would overwhelm her.

These are the first and biggest dangers that Mom is facing.

Two possible courses of treatment

We talked with the bone marrow transplant folks at West Penn yesterday. MDS has four separate risk levels; the chart nearby outlines them. Please keep in mind that the “median survival” is for untreated cases (yes, those numbers scared me very much); with treatment, they can be extended somewhat, and following a course of chemotherapy and bone marrow transplantation, an outright cure (or at least, what they call “complete remission”) is possible. And this is the treatment method they will follow.

It seems to the doctor at West Penn as if Beth is either at risk level 4 (which is the last before being on full blown acute myeloid leukemia – AML), or she has a kind of emerging AML. Both are kind of nasty. The treatment will vary, to some degree, based on which is the actual diagnosis. I’ll explain momentarily.

They took a second bone marrow biopsy yesterday to confirm which form of the disease she has. Meanwhile, she has been admitted to West Penn’s hematology/oncology unit (“hem/onc”).

There may be two possible courses of treatments. If she has the emerging AML (which at this point seems less likely), she will remain in the hospital for 30 days and undergo a pretty intensive chemotherapy. At the end of that time, she is a candidate for a bone marrow transplant. (There is a “national registry,” they will have to find a donor, etc. More about that at some future point).

If she has the MDS, there will be a lighter-weight kind of chemo and drug therapy, which may enable her to proceed on an outpatient basis. This will obviously be easier on all of us, but I believe it will take longer. And following this, they are also looking to do the bone marrow transplant.

This is a very weird disease, or set of diseases. It is a potent one; at Beth’s level, there is not a lot of life expectancy, unless the bone marrow transplant is successful. And if it is successful, there is a chance that it will result in a complete cure.

All of this is made possible by various research efforts over just the last 5-10 years.

More later, as I learn things.