• الإثنين الموافق ٢ تشرين اول ٢٠١٧ [اليوم السادس بعد الكيموثيرابي ]:
بعد حُقْنِة الصفائح Platelets التي تمَّ حَقني بها البارحة، شَعَرْتُ بِشَيءٍ مُخْتَلِف ،… فإذا مَشيتُ ،.. أشَعَرُ بِتَعَبٍ ،… وإذا أَكَلَتُ ،.. أشعرُ بِدفءٍ من الحَرارة يَغْمُرُني ويَفَيضُ من جِسْمي ،… إحساسٌ مّصحوب بِتَعَرُّق ،… تِلكَ مَظاهر لَمْ أشْعُر بها سابقاً…
ليلة البارِحة كغَيرِها من ليالي المَرْكز ،… نومٌ ولا نَوْم ،.. وليلٌ طَويل ،… وزِيارات ” حَميمة ” مُتواترة الى حَمَّام الغُرْفة ،..
أسْتَقبِلُ الصّباح كل يوم ، وبَيْنَ يَدَيَّ قَدْرٌ قليلٌ أمْلِكه من النّشاط
أكتب الآن بعد الثانية عشرة بعشرين دقيقة من يوم الإثنين ،…في السّاعَتين الأخيرَتَين ، شَعَرْتُ بالوهن والتَّعَب ،…
أميلُ الى الشُّعور بالنُّعاس أو النَّوْمِ أكثر ،…
سأحاول أن أكتشِفَ ما الذي يَحْصُل معي هذا اليوم .
بعد صِراعٍ مع المَيل الى النّوم … والنّوم فعلاً،… قَرَّرَتُ أن أترك السّرير، وأن أمارس رِياضة المَشي في الغُرْفة .
كُنتُ قد طَلَبتُ من مُنى وهِبَه أن يأخُذا إجازة لمدة ساعَتَين ، يُرَوِّحا خلالها عن نَفْسَيهما ،… وقد إستجابتا للطَّلَب ، وغادَرَتا الغُرْفة ،..!
لقَدْ أهْلَكْتُ منى ، وأهلكتُ هِبَه مع مَرَضي هذا ..!؟
في الواقع ،.. أنا أشْعُر بأنّي زَجّيتُ بجميع أفراد العائلة في المِحنة مَعي شخصيا ً…… وأنّي أرْهَقْتُ الجميع ،…
بعد المَشي ، جَلستُ أعمل تلخيصاً حول الـ AML ، أي حول لوكيميا الدم الحادة …
أَمْضيتُ نحو ساعَتين في تلك المُهِمة.
بعدها ، عادت مُنى وهِبَه ،… وأَصَرَّتا على أن أتناول حبة أڤاكادو ، وبُرتقالة خَضراء…
ثم حَصَلَ نِقاشٌ حول الحَمّام ،… هل آخذ حَمّام هذه الليلة ، أم أنّه من الأَفضل أنْ يَتِمَّ تأجيل ذلك الى يوم غَد ..!
كُنْتُ مُترَدِّداً ، وأخيراً ، حَسَمتُ الأمر ، وقُلتُ ، فاليكن حمّاماً،.. ولنأخُذ كل الإحتياطات كي لا أُصاب بِـ “بَرْدِيّة” ،…!
جاءَ عَلاء ، وجاءَتْ أماني ،،..
تَمَّ تَحضيري لأخذِ الحَمّام … ،
وها أنا أكتب الآن بعد ” حَمّام ” و”حِلاقِة دَقِنْ” كذلك ،… !.
لَاحظتُ هذا اليوم أنّي لَمْ أَتَلَقَّ حُقنة صَفائِح دَم جَديدة ،… وأنَّ هُناك بُقْعة زَرقاء مع إحمرار في أعلى يَدي اليُمنى ،… أَخْبَرَني عَلاء أنّها بِسَبَب قِلّة صَفائِح الدَّم .
Highlight on AML ( Acute Myeloid Leukemia ) Based on a pamphlet issued by ” Leukemia & Lymphoma Society”
Acute Myeloid Leukemia (AML) results from acquired changes in the DNA of a developing marrow cell.
Once the marrow cell becomes a Leukemia cell, it multiplies uncontrollably into billions of cells.
These cells, called ” leukemic blasts” do not function normally. However, they are able to geo and survive better than normal cells.
The presence of the leukemic blasts blocks the production of normal cells. As a result , when AML is diagnosed, the number of healthy blood cells ( red, white and platelets) is usually lower than normal.
•Causes
Most patient diagnosed with AMZl have no clear – cut triggering event .
•Signs and Symptoms
The signs and symptoms of AMZl are also associated with a number of other, less serious diseases. ( pale complexion, may tire more easily, have shortness of breath, signs of bleeding caused by a very low platelets count, prolonged bleeding from minor cuts, ..etc)
•Bone Marrow Aspiration and Biopsy
The tests are used to examine marrow cell to find abnormalities. The sample is usually taken from the patients hip bone. The bone marrow aspiration is a liquid sample of cells taken from from the bone marrow. The bone marrow biopsy is a core sample of bone that contains marrow.
•Confirmation of Diagnosis
The diagnosis of AML is confirmed by identifying the percentage of blast cells. Blasts are normally 1 to 5 percent of marrow cells. Having at least 20 % blasts is generally required for a diagnosis of AML. But AML can also be diagnosed if the blasts have a chromosome change that occurs in a specific type of AML, even if the blast percentage is less than 20%.
•AML Subtypes
There are many subtypes of AML . These are categorized based on the type of cell from which AML originated and the stage of maturity of the cells.
•Changes to Chromosomes and Genes
Certain changes to the chromosomes and genes can provide important information for risk assessment and treatment planning. Genetic changes may occur in patients with normal Chromosomes, so it is important to do a molecular analysis.
•Induction Therapy
The initial phase of Chemotherapy is called ” induction therapy”. This may involve the simultaneous use of multiple drugs or a planned sequence of treatments.
Two types of chemical drugs act in different ways to stop AML cell growth and lead to AML cell death. Both drugs are given to the patient via a central line. The central line is placed surgically in a vein in the upper chest. The External end of the line is attached to a port that provides access for administering medications, fluids or blood products , for withdrawing blood samples for cell counts and chemical tests.
The goal of the induction therapy is to rid the blood and marrow of visible leukemic blast cells. Generally, if blast cells are still evident after first course of induction Chemotherapy, a second course
of the same chemotherapy is given.
•Remission Normal blood cell production will return in many patients several weeks after initial treatment is completed. Blood cell counts gradually approach normal, well being returns and any remaining AML cells cannot be detected in blood or marrow. A small number of residual AML cells will not interfere with normal blood cell development, but they have the potential to grow and cause a relapse of the AML.
•Consolidation Therapy
Postremission therapy also called ” consolidation therapy “is needed to kill remaining AML cells and prevent relapse.
AML postremission treatment consists of additional intensive chemotherapy after remission has been achieved, with or without autologous or allogeneic stem cell transplantation.
Patients who do not have a transplant generally Are given four cycles of chemotherapy. If chemotherapy alone is used , the best results occur if intensive treatment is applied.
Some patients may benefit from intensive chemotherapy alone followed by one of three types of stem cells transplantation. It is an issue that is also dependent on the classification of the ANL case in question ; whether it is a low risk, intermediate or high risk.
•Refractory and Relapsed AML
Most patients achieve an initial remission. However, some patients have residual leukemic cells in their marrow even after intensive treatment. This is referred to as “!refractory Leukemia”. There ar other patients who have a return of Leukemia cells in the marrow and a decrease in normal blood cells after achieving a remission . This is referred to as ” relapsed Leukemia”.