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Clara is REALLY going home today! She has a delay before her lung surgery and they are sending her home until that is scheduled. At this point, Clara has lived in the hospital longer than she has lived here. Hopefully she will not be freaked out by the lack of beeps, constant nurse interruption, and ability to turn out lights. Brooke jokes that through the process of taking care of Clara in the hospital she has her MRN (Mother's Registered Nurse) degree and finished it with all of her training to take care of Clara when she comes home. She had to learn to change out parts of the PICC lines, give meds, and other important stuff that I am still not caught up on. Of course, any little issues and we have to rush to the emergency room.

The CT yesterday showed that the lung absess more organized and slightly smaller (1.7x1.5cm) down from (2cmx2cm). Hopefully this means that the antifungals are working. They still plan to do surgery to remove something, but we are waiting to hear if it is an entire lobe of her lung or a different procedure. We also don't know if the surgery will be this Tuesday or the Tuesday after Thanksgiving. Obviously, a longer wait at home would be preferable. The difficulty in scheduling is getting a surgeon who is good at this procedure because apparently it is very difficult.

Unfortunately, the docs also noticed a nodule of aspergillus on her kidney. It is pretty small (7mmx5mm) but the doctors won't be trying to remove it because of its location. Hopefully it resolves with the anti-fungal medications. Speaking of anti-fungals, it is really nice knowing that is is a fungal infection and only getting 2 IV medications per day instead of something like 15 when they had to cover all their bases.

We also got a new MRD measurement from Clara's bone marrow. It has actually dropped now to 0.04% from 0.21%. There are two potential reasons for this: 1) Total count of cells increases while leukemia stays idle or 2) immune response to the leukemia cells. Both are good scenarios and are likely taking place. Option 1 fits well because her counts are almost 5x what they were at the 0.21% marrow draw (though I don't know how the peripheral count matches the bone marrow count). Option 2 is in play more because of the aspergillus infection. Aspergillus is fought with a cell-mediated response which should also attack the leukemia cells. It is not going to kill them all, but may help counteract the delay in stem cell transplant.

So the new treatment plan is 4 weeks of antifungals before her re-workup for transplant. If the workup looks good the plan for transplant will be ~Jan 3. There will also be some light chemo before then to keep her marrow cell count low. Hopefully at the beginning of the year all of the infection will be gone and we won't get a flair up as soon as we knock out her immune system.