Three more days

GVHD

On Friday, at 8am, I will be in the Scripps Green Hospital, transplant unit, and the conditioning chemotherapy will begin. I will be there no less than a month, and possibly up to five. I hope 1) not to be killed by tumor lysis syndrome (TLS), and 2) that the experience will be less difficult than the one in September 2005, when I had a full autologous transplant from my own stem cells (which were collected and frozen in 1998). If I make it to a week from Friday, I will probably be OK, at least until we learn the extent to which I will have residual graft vs. host disease (GVHD). It could take months to discover, or be obvious right away (not good).

The essential difference, by the way, between a reduced-intensity allogeneic transplant from a matched but unrelated donor (MUD, which stands for "matched unrelated donor"), and an autologous transplant, is between chemical destruction of the old bone marrow (with melphalan) and biological destruction of the old bone marrow (by the donor's stem cells). The autologous does not cure, but the MUD can. However, even if the cancer is gone forever, there will be some GVHD that is often permanent. It can be mild, and it can be anything but mild to the point of attacking connective tissue or even the organs and causing death. I  believe that by having a donor with a 9/10 HLA match at the genetic level, the worst isn't going to happen. But...you never know.

It will also be good if the donor cells, which are being flown by courier here next Tuesday, are successful in attacking my cancer cells and my marrow. It is possible that I could end up with a bad result: both immune systems surviving in what is called a "dual chimera." The two won't be friendly to each other.

On the other hand, I found a new drug, recently approved for adults, that practically eliminates the risk of TLS, the only complication at all likely to kill me up front. A friend of mine, who had an autologous transplant, had TLS. His kidney functions stopped and there was risk of kidney death. He was on daily dialysis for many weeks, with other medications being pumped in to protect/restart the kidneys, but he was delirious, incoherent, and non-responsive for most of that time. I visited him often. I think he knew I was there but I could not understand him, and, later, he had only vague memories, but, amazingly enough, they pulled him through and the kidneys started to work. He was lucky. Sadly, though, he had waited too long for the autologous transplant and did not get a significant benefit from all of that suffering.

The new drug is called Elitek (rasburicase). Doctor and I agreed yesterday to add it to the protocol. The only potential problem for me is a severe allergic reaction to it, but, being allergic to nothing, I suspect I'll be ok. So the risk of immediate death drops from 20% to something much lower and I no longer am apprehensive about the next week or two. The Russian Roulette game is now being played with a couple of extra empty cylinders.

Today I must finish a revision to my will and add a codicil. It isn't what I needed (family trust, etc.) but it will be enough.

N.B. — My head is full of dex, so I might be incoherent myself today. Sorry.