This post reflects our experience under the Children’s Oncology Group (COG) protocol 9032 for Standard Risk acute lymphoblastic leukemia. Treatment plans vary. Always consult your child’s care team for guidance specific to your child.
Interim Maintenance II lasts 56 days and is the fifth and final phase of frontline treatment. Frontline treatment refers to the initial portion of the 2–3 year course of therapy for acute lymphoblastic leukemia.
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Days Spent Inpatient
NONE.
Unless you count the clinic day when they were at capacity and put us in an inpatient room. Those inpatient halls felt distant and familiar all at once.
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Medical Details
- 2 intrathecal chemotherapy doses via lumbar puncture
- 10 doses of IV-administered chemotherapy: Vincristine and Methotrexate
- IV Methotrexate escalation based on blood counts, beginning at two-thirds of the highest dose reached during IM1
- Beau started at 200 mg and escalated through to 400 mg
- 5 clinic visits
- 5 local lab blood draws
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Chemotherapy / Treatment Symptoms We Had
Neuropathy
Beau experienced mild neuropathy during this phase—significant enough to wake him in the middle of the night and send us into a brief panic, but mild enough that it resolved with aggressive hydration and magnesium oil massage. We also consulted our naturopathic oncologist who suggested some supplements to help with neuropathy.
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Chemotherapy / Treatment Symptoms We Missed
Mouth sores.
Infection.
Nausea.
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The Hardest Part of Interim Maintenance II
Starting IM2 was harder than I expected.
I thought I would feel relief on the other side of Delayed Intensification. Instead, I felt dread. More chemotherapy. More low counts. More time being that cancer family.
In reality, IM2 turned out to be a straightforward phase. And like so many things in this journey, if I had known then what I know now, I wouldn’t have worried nearly as much.
During IM1, after Beau’s final Methotrexate escalation, he became very sick and spent most of a weekend vomiting. Obviously from the Methotrexate. A week later, the rest of us got the stomach flu.
Fast forward to IM2, and I was braced for history to repeat itself. Surely once he hit the 300 mg mark, he’d be sick again.
Nope. Nothing.
With each escalation, he felt fine. Once he dropped sedation for his lumbar punctures (more on that in another post), you would never have known he was receiving chemotherapy. He moved through IM2 without noticeable side effects.
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Biggest Surprise of Interim Maintenance II
At our clinic appointment on August 23rd, Beaudin chose to do his lumbar puncture without sedation.
I’ll write about that separately, but I’ll just say this: it was a game changer, and I have all the feelings.
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Additional Notes
Over Labor Day weekend, Beaudin broke his collarbone after going head over handlebars while mountain biking.
At first, it didn’t seem broken. His range of motion looked okay, and we assumed it was badly bruised. At the next clinic visit, the doctor suggested an X-ray—and sure enough, it was fractured.
Thankfully, it wasn’t a full break but what’s called a greenstick fracture—like trying to snap a young twig where only part of it breaks. Because chemotherapy can affect bone density, the images were reviewed by an orthopedic oncology specialist.
His conclusion? Completely normal. A side effect of childhood.
I cried.
YES. A SIDE EFFECT OF CHILDHOOD.
I have never been more excited about a broken collarbone in my life.
When we told friends and family, many said some version of, “Oh gosh, one more thing, Betsy.” And I found myself explaining how joyful it felt to be dealing with something so beautifully normal.
Yes, a broken collarbone is inconvenient. Yes, it was a damper on the end of frontline treatment. But it happened because he was being a kid—a normal kid—who took a hill too fast on a mountain bike ride in the Colorado sunshine and went head over handlebars.
Have you ever heard of anything more gloriously normal?
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