Howdy. Welcome to the newest addition to my list: the Sanctuary Covenant Church prayer team. I don’t know who you are, but you’ve been added. You’ll probably need some background on this, which I won’t provide in this email. Check your other messages for previous emails, and let me know if you need further info.
First, a big congratulations to Sean Veling, who was the first person to provide the correct answer to the trivia question posed in the last update. Sean, you need to pick a place for dinner. Second, you older people who cheated should be ashamed of yourselves. I know you cheated. There’s no other way you could have guessed that Sir Mix-A-Lot wrote “Posse On Broadway.” Unless, of course, you happened to be standing outside my bedroom when I listened to it repeatedly during my youth in attempts to memorize the lyrics.
While in Seattle, I didn’t get a chance to trace the route of Mix-A-Lot and his posse. I did, however, spend an unusually long time in the rental car, attempting to navigate the maze of streets with names like S 43 NE W and SE 43 N SW. Absolutely ridiculous. I yearned for the streets of Lancaster, where every street runs east-west and north-south, and is named accordingly. Luckily, we had the cell phone number of a friend in the area, who was kind enough to answer his phone several times and point us in the right direction. Russ–thanks for the help, and for the hospitality.
Turns out that Dr. Joe So-and-so is actually Dr. Frederick Applebaum, the executive director of the Fred Hutchinson Cancer Research Center (aka the Hutch). It’s nice to know that I have some clout. Fred was a welcome change from Dr. Sauerkraut, er, Blume from Stanford. We talked for a couple hours, and he explained some things more clearly so that we gained a better understanding of CLL. In the end, the recommendation was a low-dose allogeneic transplant. If you remember from the Stanford follow-up e-mail, Stanford recommended a high-dose allogeneic transplant. The difference is in the amount of chemotherapy and total-body radiation given to the patient. In the low-dose scenario, the chemotherapy dosage is similar to that already given to the patient in previous rounds of chemo. The radiation dosage is also low, but I don’t have the exact numbers in front of me. All things considered, the low-dose approach is much less toxic to the patient in comparison to the high-dose approach.
The recovery time is potentially a few months shorter, as well. I would still have to go to Seattle for the transplant, and live there for about 3 months. I would probably go through most of the procedures as an outpatient. Everything else is essentially the same–full-time caregiver, special diet, minimize exposure to potential infection sources, etc. After the three months, I would come home (assuming all is well) and continue recovery for the next 3-6 months.
The logic behind Seattle’s recommendation is pretty simple. So far, the data collected on low-dose transplant patients shows that there is a 70% success rate, compared to a 40-60% success rate for the high-dose transplant patients. The low-dose transplant is less toxic, and there is still another option (high-dose) if it is unsuccessful in curing the patient. While the risks are the same (graft-versus-host disease, infection), the low-dose approach looks like the better choice. I’m also pretty confident in the choice of going to the Hutch as opposed to Stanford. They were pioneers in the field of transplants. Of the 14 transplants done for CLL patients, 12 were done at the Hutch. Yes, you read that number correctly–there have been only 14 transplants of this type for CLL patients. This is because the typical patient is over 50 years old and other treatments are successful in providing an acceptable quality of life until they die of other causes. I’m not in that group.
Fortunately, this isn’t a decision that requires immediate attention. The doctors would like to see how I respond to the next round of chemotherapy before pursuing a transplant. I saw my doctor last Monday, and there’s not much going on. White cell count is 58,000, which is down several thousand from the last time I saw him. Apparently, these fluctuations are normal. The good thing is that the total count isn’t rapidly rising right now. So, no chemo for me yet. I’ll continue getting monthly blood tests and return to the doc in February.