Doctors have found that Neuroblastoma responds well too many forms of cancer fighting medicines and techniques. Since Payton has high risk neuroblastoma, she has an intensive treatment plan that is expected to take about 15 - 18 months. This intensive treatment plan includes chemotherapy, surgery, two back-to-back stem cell transplants, radiation therapy, and immunotherapy. The plan is divided into three stages: Induction, Consolidation, and post-Consolidation.
Induction: Chemotherapy is used to kill and shrink as much of the tumor as possible. Payton is expected to do about 4 cycles of chemo before surgery and one cycle of chemo after. Each cycle of chemo is about 21 days, the first 5 days will be inpatient at John's Hopkins where Payton will be given her chemo medication through her IV. After day 5, she is in "recovery" where typically her blood cell counts will go down and then slowly start to go back up. The hope is that Payton will be able to "recover" at home for those two weeks between cycles. Once her counts are at a good number, she will be able to move on to her next cycle of chemo.
Surgery will ideally happening between chemo cycle 4 and 5. The tumor should be much smaller and easier to operate on. Surgery will probably not be able to remove the entire tumor, which the doctors are expecting and prepared for.
Consolidation: During consolidation, very high doses of chemotherapy are given to kill any remaining cancer cells. This chemo also destroys healthy bone marrow, where blood cells are made. Because of this, the doctors will harvest Payton's bone marrow while it is still healthy right after cycle 2 of chemo. Her harvested bone marrow will go to a lab to be stored until her bone marrow transplant day.
A bone marrow transplant is a procedure that helps the body make new healthy blood cells to replace the blood cells that may have been harmed by the chemo. Payton's own steam cells that were collected during induction will be given back to her by an infusion into her IV. This process is called an autologous stem cell transplant (ASCT), meaning your own blood stem cells are infused rather than cells from a donor.
Payton will have two back-to-back stem cell transplants. From my understanding, she will be given a cycle of very high does of chemo first, then the stem cell transplant to help her body recover and replace harmed blood cells. Each transplant we are expecting to spend 4-5 weeks in the hospital. This will help the nurses and doctors keep a very close eye on Payton as she recovers. The doctors plan to send us home for some time between the two transplants, to help with our emotional recovery.
Once Payton has healed from her bone marrow transplants, radiation therapy will begin. Radiation therapy uses high-energy x-rays to target and destroy any remaining cancer cells.
Post-Consolidation: Immunotherapy treatment is given for the last 6 months of treatment. These drugs will help Payton's immune system find and kill any remaining or hiding cancer cells.