Yesterday Kim went in for another lumbar puncture and today we had an appointment with her doctor to discuss the plan going forward. The idea is for Kim to go in to the hospital every other week to receive high dose Methotrexate as an inpatient. They will also give her regular lumbar punctures to continue to infuse drugs directly into her spine as well as to monitor the levels of lymphoma floating in her cerebrospinal fluid.
If the levels of lymphoma eventually fall far enough they will do another MRI to check the size of the tumours in her spine. Assuming those have shrunk they will go back to trying to address the tumours elsewhere using a different chemotherapy protocol.
The biggest concern at the moment is the toxicity of the Methotrexate. The dose they give is large enough to be considered lethal and it is only the "rescue" drug (leucovorin), which they give 24 hours later that keeps Kim from succumbing to the effects. If complications start to arise due to the Methotrexate then they will have to stop giving that drug and come up with a new plan.
Tonight Kim was feeling pretty good so she and I went out for supper to our favourite pizza place, Pizzeria Libretto. It was great to get out and do something normal.