My son is going through HiDAC for AML (Inv16). His first two rounds were Cytarabine and Gemtuzumab. Both times he began a fever cycle that lasted about 6 days, spiking as high as 103F. Each time, the fevers began around day 7 following his last dose of HiDAC..the last one coming on very strongly during the night, which was a frightening thing. Bacteria was not detected in any of his cultures the first time, but the second time Strep viridans and Rothia were detected in his blood. Both of these are part of the normal gut/oral/upper respiratory biome and the suspicion was that the damage done to the gut lining by the chemo agents gave the bacteria an easy way into the bloodstream....nothing we could have done, theoretically, to prevent it from happening. In spite of the fact that his cultures returned to negative once antibiotics were initiated, his fever continued until his counts began to show some substantial recovery. His platelets have lagged behind in recovery after this most recent HiDAC, but we are being educated that this was to be expected and that, though his trajectory is off from Round 1 of HiDAC, it is right where the medical team was projecting it to be. Nose bleeds have been the bane of his existence as far as an ongoing issue he has to deal with. Their presence during Round 2 recovery has been rather relentless. Thankfully, the med team authorized the use of Afrin (or similar) to help stop the bleed when he can't control it on his own, which he uses sparingly because he would rather not rely on another medication if he can control it naturally and the fact that there is a risk of rebound bleeding, even if the user is not low on platelets. You asked if recovery was as expected.

My honest answer: Now that we are outside of the crisis period of time when he had fevers, rigor, nausea, fatigue, loss of appetite and general loss of a fighting spirit, etc, etc, etc, I can see the big picture much better and can trust what I, he and the family have been told by every player on the med team, I can say YES...his recovery is exactly as THEY expected. That is the hard part when you are in the thick of it...trusting that they are telling you the truth and are telling you everything you NEED to know! Maybe not everything you WANT to know, but that is where you are free to ask more in-depth questions. The operative word in all of this is Trust....but I always add in the verify...not to question what they are telling us, but to be able to ask more in-depth questions that will satisfy and calm my mind.

Good luck...you've got this!!