Bone Marrow Transplant Details

SATURDAY, AUGUST 23, 2008 02:26 PM, CDT
After the good news on Thursday things continued to go well for me. I was told that the first infusion of Campath is the one with the worst side effects. After a night without fevers, chills, or any pain, I would have to agree. The only problem staying overnight at the hospital was being woken every hour when the nurses took vital signs.
Friday was another long day at the hospital. In addition to finishing up the Campath and getting hooked up to my EPOCH bag, I had two other tests. I had a Pulmonary Functioning Test and an Echocardiogram. The techs told me after each test that my lung and my heart were looking good. Thats great news looking forward to the Bone Marrow Transplant.
After those two tests I met up with Kate at the hospital. She and I got an opportunity to speak with the transplant doctor for about a half hour. He let us know that there were 600 potential donors from the search, and that it gave us an 80 percent chance of finding a match. That was pretty good to hear. He also went into detail about the three different types of transplants that are done for lymphoma patients.
The lead research doctor told us 3 weeks ago that an autologus transplant, which uses a patients own stem cells to replace the decimated bone marrow, would be unlikely to provide a long term cure. The transplant doctor said that he thinks all 3 transplant options would be good for me, but was less enthusiastic about this option because of how quickly I relapsed after going into complete remission.
The other two transplant options are called allogeneic transplants. They require taking bone marrow from a donor. The traditional way of doing this is called a myelooblative transplant. Myelooblative, also called a high intensity transplant, requires radiation and high dose chemotherapy to virtually remove all of the bone marrow in my body before the transplant. The good news about this transplant is that it has the best results in terms of complete remission. However, it also has the highest mortality rates...about 20-30%. The transplant doctor said if I were a 15-17 year old, that he would definitely reccomend this option. His thinking is that younger patients are just able to handle the high dosage of chemotherapy without complications. He stated that at my age I am in the middle ground but leaning towards the younger side. So this wouldn't be a bad option in his opinion.
The more recent development in stem cell transplants is the non-myelooblative transplant, also known as low intensity. The thought behind this procedure is that a complete elimination of the recipient's bone marrow isn't necessary, and that an allogeneic transplant could be done with smaller doses of chemotherapy. The difference between the myelooblative and non-myeloblative transplants is a reduction in half in both mortality rates and successful remission. The mortality rate for his treatment is 10%, however the percent of those achieving complete remission is between 25-75%. Thats a pretty big range in my opinion. However, the 1 in 10 chance of mortality sounds a lot better than 20-30% to me.
The doctor shared that to be eligible for a low intensity transplant, that a person's tumor has to be viewed as chemo sensitive. The number needed to be chemo sensitive is 50% improvement. Since I received an 80-90% improvement on just 1 cycle of EPOCH-C, I am already seen as a good match for this treatment. The doctor stated that the best predictor of success in these transplants is cancer sensitivity. Because of my positive results so far, he feels that I would be a great candidate for a non-myelooblative transplant.
OK...so thats a lot of information and I imagine it could be quite complicated for people. At this point I feel like going forward with the non-myelooblative transplant. I feel like the chemo works well on my cancer, and that I will likely be in remission again like I was back in January. That would give me a great chance of long term remission with this treatment, and I could avoid the higher potential mortality rates that the full intensity treatment has. NIH also offers the low intensity transplant, which would allow us to stay local with my treatment. Having to go to another city to have the transplant would be worthwhile if there was a better option. However, I feel comfortable with the program at NIH, and I trust that my doctor's are learning how to treat my cancer. As the transplant doctor said, "Its not like you have even 100 patients with your type of disease to give us an idea of what should be done." Other hospitals just might not have a good idea of what to do with my diagnosis.
Staying at NIH will also allow my family to visit easily without the stresses of travel. Kate will have a lot on her hands with a sick husband at the hospital and a 2 year old to watch at home. So the family support will be very important during this ordeal. So things are looking good for my continued treatment at NIH. The doctor just reccomended that I continue to eat healthy, exercise, and stay in as best shape as possible. Assuming the chemotherapy continues to go well, things are looking up. Unfortunately it will be a long process. The doctor stated that it takes about a year's committment after this procedure. However, he said that once I leave the hospital I should be able to endure most activities that I normally do. The one thing he did state was that yard work would not be reccomended. Oh well...there goes one of the things I like to do, but it could be worse!