So here I was, faced with a dilemma. I was feeling fine, but diagnosed with what typically is considered a very aggressive form of lymphoma. My first reaction, was to go for the aggressive approach, i.e. chemotherapy, total body irradiation (TBI) and periferal blood stem cell transplant (PBSCT). My oncologist was equally aggreeable to this decision, and sent me off to the transplant specialists at Kaiser, who work in conjunction with doctors at City of Hope, for a consultation.
While there, I was given a slew of blood tests for HLA typing. That is essentially an analysis of the blood, performed in order to find a compatible transplant donor. As it turned out that was the pleasant part of the visit. I then met with a transplant specialist who proceeded to inform me of all the potential hazards of my selected treatment plan.
She went on to inform me of the known effects of chemotherapy, and the increase risks of contracting other cancers as a result of the total body irradiation. But the really disturbing part was the high mortality rate associated with a transplant.
In the case of an autologous transplant (your own cells are cleansed of all disease, and reinfused into your body) the initial treatment, high dose chemotherapy plus TBI, is designed to destroy your entire immune system to make way for the cleansed cells. This leaves you open to a whole slew of complications, which I won't even go into, but does require you to maintain a good sterile environment, for anywhere from several days to months, depending how long it takes for the cleansed cells to rebuild the immune system. Since you are infusing your own cells, the mortality risk is low, but the potential for relapse is almost a certainty.
In the case of an allogeneic transplant, your entire immune system is stilled destroyed, as with the autologous transplant, but instead of reinfusing your own cells, you get the cells of a matched donor, who never had any hint of disease. Obviously this procedure makes a lot more sense, if you hope to be cured, but in addition to the complications of a destroyed immune system, this procedure also leaves you open to what is affectionately referred to as Graft vs Host Disease (GVHD). Depending on how perfect the match is this could range from very mild to accute, and could result in the need for anti rejection drugs for the rest of your life or even worse.
A new and less destructive procedure called a nonmyleoablative (mini-allogeneic) transplant, does not require the same high dose chemotherapy or TBI, but still leaves one open for GVHD. In my opinion, this procedure does offer the best chance for a cure, but the risk of GVHD suggests that even this procedure should be the treatment of last resort.
It was at that point that I decided that more research needed to be done. Were there other, more or equally, effective treatments out there, which I was not being informed of, or my doctors were unaware of. I was still feeling fine, and did not feel the compulsion to rush into anything which carried such high risk.
So for the moment I was in the do nothing mode, sometimes referred to as "Wait and Watch" or more appropriately "Watch and Worry"!
While there, I was given a slew of blood tests for HLA typing. That is essentially an analysis of the blood, performed in order to find a compatible transplant donor. As it turned out that was the pleasant part of the visit. I then met with a transplant specialist who proceeded to inform me of all the potential hazards of my selected treatment plan.
She went on to inform me of the known effects of chemotherapy, and the increase risks of contracting other cancers as a result of the total body irradiation. But the really disturbing part was the high mortality rate associated with a transplant.
In the case of an autologous transplant (your own cells are cleansed of all disease, and reinfused into your body) the initial treatment, high dose chemotherapy plus TBI, is designed to destroy your entire immune system to make way for the cleansed cells. This leaves you open to a whole slew of complications, which I won't even go into, but does require you to maintain a good sterile environment, for anywhere from several days to months, depending how long it takes for the cleansed cells to rebuild the immune system. Since you are infusing your own cells, the mortality risk is low, but the potential for relapse is almost a certainty.
In the case of an allogeneic transplant, your entire immune system is stilled destroyed, as with the autologous transplant, but instead of reinfusing your own cells, you get the cells of a matched donor, who never had any hint of disease. Obviously this procedure makes a lot more sense, if you hope to be cured, but in addition to the complications of a destroyed immune system, this procedure also leaves you open to what is affectionately referred to as Graft vs Host Disease (GVHD). Depending on how perfect the match is this could range from very mild to accute, and could result in the need for anti rejection drugs for the rest of your life or even worse.
A new and less destructive procedure called a nonmyleoablative (mini-allogeneic) transplant, does not require the same high dose chemotherapy or TBI, but still leaves one open for GVHD. In my opinion, this procedure does offer the best chance for a cure, but the risk of GVHD suggests that even this procedure should be the treatment of last resort.
It was at that point that I decided that more research needed to be done. Were there other, more or equally, effective treatments out there, which I was not being informed of, or my doctors were unaware of. I was still feeling fine, and did not feel the compulsion to rush into anything which carried such high risk.
So for the moment I was in the do nothing mode, sometimes referred to as "Wait and Watch" or more appropriately "Watch and Worry"!
Comments