December 16, 2008

Well, we just returned from the hospital after speaking with the bone marrow transplant specialist. As with all things that are new to you - you learn quite a lot and the doctor is very patient and a very good teacher.

The bottom line is that with a continued regimen of chemo without a transplant there is about a 5% chance of making a full recovery - certainly not the best of odds. Likewise, should there be a relapse(obviously there is a 95% chance of that) - the cancer cells that come back would be very hardy because they would have survived all the chemo up to that point. It would then take even stronger doses of chemo to try to get rid of them. Given the fact that I am taking the 2nd strongest set of chemo drugs - there is only 1 option left - if that does not work then I would be out of luck. A bone marrow transplant would not be feasible at that point because I would no longer be in remission.

Now for the transplant option. Statistically, there is about a 40% chance of success with the transplant. For me this is an increase from my first visit to the doctor who said that there was about a 30% survival rate for someone my age. However, these are just numbers and do not necessarily apply to me!

Now for the normal vs reduced transplant approaches. Knowing that I would never explain it properly, I have excerpted the following explanation for a reduced intensity bone marrow transplant. Once the bone marrow has been transplanted, the....

"Reduced intensity conditioning refers to a conditioning regimen that uses less chemotherapy and radiation than the standard myeloablative conditioning regimen. Myeloablation is the result of an intensive conditioning regimen in which the bone marrow cells are destroyed. The goal of using a reduced intensity conditioning regimen is to decrease the transplant-related complications, toxicity and mortality. However, since myeloablation may not be achieved with this approach, the risk of rejecting the transplant may be higher compared to a full-intensity (myeloablative) conditioning regimen."

According to the doctors a full regimen of chemo and radiation would most likely be too much for an older person to withstand. However, the amount of reduction is somewhat based upon a person's overall health. The idea is to increase the likelihood for the patient to survive the procedure even though the overall likelihood of enacting a cure may be somehat reduced. It's trying to avoid the old joke about the operation being a success but the patient died. As I read further on this, the reduced intensity is also supposed to apply to the pre-transplant treatment as well which could result in not having all the cancer cells removed. That is most certainly not my situation and further explains why I have to go in tomorrow for the 5 and 2 regimen which is intended to keep me in full remission.

A few other points of interest were also discussed. I found out that my sister was only a 50% match for the transplant having matched 3 of the 6 criteria that make up the HLA values that the doctors use to seek compatible donors.

The doctor did a quick search of the bone marrow bank while we were there and came up with approximately 90 donors from around the world that will have to be further checked in detail to winnow it down to the most compatible ones. So it seems that we are off to a good start. It will probably be a good 2 months before the transplant will actually take place given the holidays, the donor filtering process, contacting the possible donor(s), etc.

Lastly, the doctor stated that the reduced intensity transplant only involved a hospital stay of about 8 days. Boy was that good news! People were telling me that I would be in for weeks. It does mean frequent trips to the hospital to monitor my recuperation - but I'll gladly pay that price! Unfortunately, my wife will have to pay it, too(she's been doing the driving)!

That's enough for today. Tomorrow I should be starting round 2 of chemo with the expectation that I will be back home on Monday. So it looks like the next installment will be from the hospital.

All for now....

Bob