Milestones

Modified

December 25, 2024

For Sam’s one year anniversary post I generated a more coherent timeline of his the more significant events in this cancer journey.

Sam has been through three eras of cancer treatment:

  1. Chemotherapy,
  2. Bone Marrow Transplant,
  3. and now Immunotherapy.

Radiation was given both before the BMT and also concurrent with immunotherapy.

Below is a review of the major milestones.

Chemotherapy

Date Description
2023
April 17 An alarming x-ray in Prince George provided evidence that Sam needed urgent care at BCCH.
April 18 Air Ambulance in the early morning and admission to BCCH’s PICU.
April 22 Transfer to BCCH Oncology Ward (T8).
April 28 Diagnosis of a extremely rare form of lymphoma.
April 29 Chemotherapy is initiated. Sam will receive an additional 6 full rounds of chemotherapy taking him into October.
June 2 Following his second round of chemotherapy Sam was discharged from the hospital for the first time. This marks the beginning of our family life at RMH. The next months we would visit the oncology clinic regularly. When it was time for each round of chemotherapy we would check into the ward for about 5 days.
July 14 Plans for a bone marrow transplant were initiated. By mid-summer it became apparent that the chemotherapy would not remove all of the cancer. The remaining rounds of chemotherapy would reduce the cancer as much as possible, and keep it from spreading to new locations, while the BMT was being organized.
Sept. 26 Preparations for BMT, baseline testing of Sam was initiated to evaluate impacts of the BMT (i.e. eye, ear, skin, and lung capacity testing).
Oct. 15 Sam completed his final round of chemotherapy.
Oct. 23 Targeted radiation therapy over three days to destroy the central mass in Sam’s chest is initiated. This was completed at the BC Cancer Centre over 10 days.
Nov. 8 Total body radiation is used to completely remove Sam’s existing immune system – to kill the blood producing cells in his bone marrow. This was done to make way for the bone marrow transplant.

Bone Marrow Transplant

Nov. 14 Bone marrow transplant is received. Sam had been admitted to the oncology ward a few days prior in preparation and would remain on ward in isolation for the next number of weeks. This was a particularly intense time as the medical team had to provide so many supports to his body
Nov. 25 First indications that the BMT was establishing – engraftment. Official engraftment would be established on Dec. 1 based on metrics from Sam’s blood.
Dec. 13 Sam is discharged from the hospital with plans to continue regular check-ins at the oncology clinic.
2024
Jan. 11 Stepping down from all of the various medications had its challenges. Sam was admitted to the ward for eight days to determine what was causing his extreme lethargy. It was a complicated picture as we all had a flu in the days prior but what Sam was experiencing was more. In the end the main issue seemed to be adrenal insufficiency.

Immunotherapy

Feb. 14 PET scan, that we were all hoping to be Sam’s last before having to go home, revealed a horror – the cancer had spread to three new locations. New battle strategies are brought into play. Plans to return home are canceled.
Feb. 29 Sam receives his first dose of Nivomulab used to intentionally de-regulate Sam’s immune system and to turn off specific protein markers on the cancer cells that allow them to hide from the immune system.
March 11 Targeted radiation starts against the three new sites. The shin and hip sites would see higher doses over four days. The T3-vertebrae would see lower daily radiation doses over ten days.
April 5 PET scan demonstrated that: a) The three new disease sites had been effectively killed using radiation, b) the central mass was stable c) However, a new site in Sam’s liver raised new alarm bells.
April 11 Biopsy of the liver revealed that this mass is not Sam’s original cancer but an indistinct mass that will be monitored.
April 21 Five day break – home! Two days of travel and three days in Prince Family, school, quick visits with friends, and an initial connection with the local medical team.