A cat among the pigeons...

How could I not include this in my post? I actually don't get many comments on my posts. Maybe this will get the ball rolling. 

If you are a regular follower of this blog, you may recall way back when I mentioned that at the time of my diagnosis, in June, 2021, we were told that, due to my age (74 at the time) bone marrow transplant was not an option for my treatment. That pronouncement, it seems, was based on statistical data that showed transplant treatment was just too risky in older individuals. 

A lot has changed in thirty-two months. Due to the fact that I have tolerated three different regimens of chemotherapy so well, the oncology staffs at Kaiser and at Oregon Health & Science University (OHSU) agree that considering a bone marrow transplant is "a conversation we should be having."

On Friday, we had a conversation with Dr. Meyers at OHSU. Gabrielle Meyers, M.D., is a charming woman who knows her stuff. She is a bone marrow transplant specialist with a sub-specialty in transplant treatment of geriatric patients. 

What we learned is that bone marrow transplant is no walk in the park. In previous consultations with OHSU oncologist Rachel Cook, we learned that an "acceptable" donor match determination depends on 10 genetic markers that are compared between donor and recipient. A perfect 10/10 match produces the most predictable results. The best match that has been previously found for me is 7/10, unacceptable risk. 

In the meantime, studies have shown that two of the ten markers are much less important than previously thought, and the eight remaining markers are now the gold standard. Of those, there are some donors with whom I share a 7/8 match, and that, Dr. Meyers told us, is something they can manage, thanks to "rapid expansion of our experience in doing 7/8 matched transplants."

If I understood what we were told correctly, and mind you we felt as if we were drinking from a fire hose, the science behind the treatment of leukemia with a bone marrow graft is more than simply substituting new marrow for old. 

The biggest complication involved in transplant therapy is relapse of the leukemia post-transplant. This can happen because it is impossible to eliminate 100% of the host's (that's me) stem cells via chemotherapy. It is damaged stem cells that produce the leukemia cells, so elimination of those damaged stem cells needs to happen. 

When the donor stem cells are introduced via a process that was described to us as "very much like a transfusion, only with a lot more people in the room," they begin to repopulate the bone marrow with healthy stem cells. In essence, the recipient receives a new immune system, which begins to eliminate "threatening" substances, like bad stem cells and marrow cells that may have been left behind and remaining leukemia cells, if any. To put it succinctly, per Dr. Meyers, "transplant relies on the new immune system to cure the disease."

But hold the phone, how does the new immune system know where to stop?  Aye, there's the rub. Two things can and do happen with the new immune system: the good and the bad. The good is that the new immune system fights infection and fights off the leukemia. Remember, the biggest complication post transplant is relapse of the leukemia. So, in a perfect world the new immune system is curing the disease by killing off any remaining damaged stem cells and/or leukemia cells. 

But then there is the bad side of the equation. If the graft decides that healthy host (recipient) cells are the enemy, the new immune system will attack them in a scenario called Graft Versus Host Disease (GVHD). You can think of this as being similar to auto-immune disease. The body's immune system (in this case, the newly installed immune system) attacks the body's own tissues. 

GVHD,  depending on how severe it is, can be prevented or minimized with post treatment chemotherapy. The goal is to keep any GVHD that should appear in check medically, so that it doesn't become chronic and debilitate the patient's organ systems, much in the same way autoimmune diseases are controlled. We are told that newer drugs for this purpose are available. 

Now, this all sounds pretty straight forward on paper. I wish my leukemia were on paper, but it is not. It is in my body, and it means business. We asked Dr. Meyers about prognosis after transplant therapy. In the past we have heard figures bandied about like "chemotherapy has a 50% chance of curing leukemia, but transplant has an 80% chance." Or, "the five year survival rate for patients with chemotherapy treatment is 10-20%, whereas the five year survival rate for transplant patients is 30-40%." 

Dr. Meyers' reply was a bit sobering for me. She said, if I recall correctly, that "most post-transplant deaths occur during the first year following transplant. So, if you can make it through the first year, your chances of survival improve." Somewhere in there, I came away with the notion that she was talking about a 50% one year survival rate, post transplant. 

Was Friday's conversation a success? Yes, I think we learned a lot. Was it satisfying? I would have to say, not really. I think we came away with more questions than answers. Consequently, we need to have some more conversations, before I will feel comfortable making a decision to proceed (or not) with transplant therapy. 

The decision we did make was to proceed with the evaluation process. After our meeting, we went to the lab, where some of my blood was drawn to evaluate certain antibody/antigen information that  will help to decide which donors, if any, offer the most promise for successful transplant. 

In addition, Dr. Meyers wants to do some tests that are more in the nature of sociometric evaluations. In other words, am I emotionally and mentally a good candidate for transplant therapy?

To be completely honest, the previous conversations we had with Dr. Cook, when we were told, "There are no suitable donor matches for you," were easier for me. I can accept that there are no options more easily than I can accept that there ARE options, but they have very fuzzy boundaries. 

This decision will require a great deal of thought and even more prayer. I have been in prayer for general guidance about treatments going forward, but I now realize that this decision is solely mine to make. Please, if you are a praying person, join me in beseeching the Lord for guidance in making this impossible decision; that I would yield to His will, whichever way that may take me. 

I told Dr. Meyers that, if it were not for Jill and the vows I took to love, honor and cherish her, for richer, for poorer, for better, for worse, in sickness and in health, I would probably not have come this far in my war with leukemia. And like the Apostle Paul I think:

If I am to live in the flesh, that means fruitful labor for me. Yet which I shall choose I cannot tell. ²³ I am hard pressed between the two. My desire is to depart and be with Christ, for that is far better. ²⁴ But to remain in the flesh is more necessary on your [Jill's] account. (Philippians 1:22-24)

It is the next sentence that puts the cat among the pigeons: 

Convinced of this, I know that I will remain and continue with you all, for your progress and joy in the faith, ²⁶ so that in me you may have ample cause to glory in Christ Jesus, because of my coming to you again. (Philippians 1:25-26)

Paul is addressing the church that he planted in Philippi, not his wife, for he had no wife. How does this passage apply, or does it apply, to the situation in which I find myself? God knows...I hope He will show me the way.