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Stem Cell Transplant ?

Posted by Frederick Wasti
Apr 14 2012

I am having a bit of difficulty composing this blog entry, so please bear with me...

After my infusions on Wednesday, Diane and I had a couple of meetings, one with Dr. Vincent Ho and one with Irene Heffernan (a nurse), both of the Dana-Farber stem cell transplant program, and then I also agreed to have a few vials of blood drawn for starting a preliminary transplant donor match search. (I have not yet agreed to initiate a formal donor match search, which is a lengthy, involved procedure, and which would require a formal commitment on my part before it would take place.)

The facts:

There is no fully successful chemical treatment for CLL - that is to say that there is no chemotherapy for CLL that could ever result in a cure. The only means to ever possibly achieve an actual cure is to undergo a successful stem cell transplant procedure. It is virtually impossible to kill off all of the aberrant lymphocytes in CLL, so that any ~apparent~ remission is always only temporary, as the relentless CLL cells ~always~ eventually return in number after chemotherapy. (Yes, I already knew this.)

The only possible ~true~ cure for CLL is to destroy a patient's own immune system, and to replace it with stem cells from a healthy well-matched donor, cells that would take over as the new immune system for the benefit of the adopting host. However, there are risks and trade offs involved in any stem cell transplant procedure, making the choice between chemical therapy and a stem cell transplant not a simple one to make at all. (I already knew all this as well.)

Dr. Ho did explain why a stem cell transplant can be advantageous, especially for CLL patients such as me (I have poor prognostic indicators, which predict rapid progression - that much I already knew), and that it might be best to soon transition from the clinical trial to a stem cell transplant procedure at such time as might be optimum. Although stem cell transplants are not generally recommended for early CLL treatment in most patients, someone with my prognostic indicators is unlikely to have as deep a remission with any follow up chemotherapy as with the first one, so transplants are indeed now being recommended as part of first-time treatment for people such as myself. (I had learned from my "regular" D-F doctor, David Fisher, of this shift in strategy only recently.)

Because of the time that it takes to carry out a search for a suitable donor, it is now advisable for me, according to Dr. Ho, to decide very soon to pursue a stem cell transplant procedure, if I am to have the highest chance of success with one, due to (hopefully) being in as deep a remission as possible at the time of transplantation, without waiting until the leukemia cells return in number later on. (This is a somewhat novel concept to me, one which I had thought of only obliquely before now.)

The bottom line is that Dr. Ho would recommend deciding within the next couple of weeks to have a stem cell transplant. I am stunned. It is not the idea of having a stem cell transplant that is most difficult to accept - it is the thought of having to decide for or against a transplant on such short notice that is so unsettling, at least it seems so at this moment.

So, I have been spending a lot of time over the last couple of days researching scientific literature online (trying to learn as much as I can about the ramifications of a transplant procedure), but I may also have been guilty of trying to put off writing this post, too, since I still really didn't know quite what to say or how to say it very well. Perhaps I could delete all of this and start over again, but I think I'd also end up feeling like deleting any second attempt as well. And so, maybe I should just let this go for now. (?)

I will have more to say about this in upcoming posts...

Categories: Leukemia