Last night, like every other night for the past two and a half years, Rudi took his oral dose of 6-MP, or Mercaptopurine. Three little tablets, each more or less the size of a regular strength Aspirin, 6-MP is known as a purine antagonist, and is classified as an antimetabolite. In simple terms, it disrupts or impairs the ability of cancer cells to reproduce, after the drug is incorporated into the metabolic system or the cancer cells:
Mercaptopurine (6-MP) competes with hypoxanthine and guanine for the enzyme hyphoxanthine-guanine phosphoribosyltransferase (HGPRTase) and is itself converted to thioinosinic acid (TIMP). This intracellular nucleotide inhibits several reactions involving inosinic acid (IMP), including the conversion of IMP to xanthylic acid (XMP) and the conversion of IMP to adenylic acid (AMP) via adenylosuccinate (SAMP). In addition, 6-methylthioinosinate (MTIMP) is formed by the methylation of TIMP. Both TIMP and MTIMP have been reported to inhibit glutamine-5-phosphoribosylpyrophosphate amidotransferase, the first enzyme unique to the de novo pathway for purine ribonucleotide synthesis. Experiments indicate that radiolabeled Mercaptopurine may be recovered from the DNA in the form of deoxythioguanosine. Some Mercaptopurine is converted to nucleotide derivatives of 6-thioguanine (6-TG) by the sequential actions of inosinate (IMP) dehydrogenase and xanthylate (XMP) aminase, converting TIMP to thioguanylic acid (TGMP).
Don't feel bad if you didn't understand a word of the above description, which was taken from the FDA pharmacology website. I didn't understand a word of it either.
What was different about last night was the fact that those three little tablets were the very last three in Rudi's three year and four month chemotherapy treatment for T-cell ALL. One thousand, two hundred, and fourteen days... of hell, at times, but mostly decent, or even pretty good times, all things considered (after the first year of misery was over, of course).
I really didn't know how it would affect me, but it was anti-climactic. I was expecting in part a huge sense of relief, and a wave of emotion, as I have protected myself from that over the last three plus years. But last night, there really was nothing, just a transition from a series of days where your child takes some pills each evening, and you try to remember to tick off a box, to a new series of days where your child no longer has to take those pills, and you do not have to tick off a box.
I really didn't know how it would affect me, but it was anti-climactic. I was expecting in part a huge sense of relief, and a wave of emotion, as I have protected myself from that over the last three plus years. But last night, there really was nothing, just a transition from a series of days where your child takes some pills each evening, and you try to remember to tick off a box, to a new series of days where your child no longer has to take those pills, and you do not have to tick off a box.
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