Monday, November 13, 2006

Anyone want to flip a coin?

I'm sorry I haven't written much lately, folks. I guess I was just waiting for a chance to tell you about something significant. I'll get to that, but I'll fill you in on what's been happening in the meantime. Basically, chemo chemo and more chemo. I've been coming to Roswell every other week for three weeks, getting methotrexate in my spine and big bags of yellow-green fluid in my bloodstream. There have been delays and general annoyances, but things generally have been going according to plan.
Over the last few weeks, though, I have become somewhat bothered by the prospect of bone marrow transplant. I did a lot of reasearch, much of which reccomended that my particular type of leukemia responds well to chemotherapy, and that because of the pretty severe risks of bone marrow transplant it is usually reserved until if or when the leukemia relapses. After some effort, I finally got to meet with Dr. Baer today to discuss the matter.
Now, doctors being doctors, Dr. Baer would not tell me what to do. As I understood it, I have T-cell ALL, which is the kind of the disease that response best to chemotherapy. As it turns out, though I am T-cell positive, there is a slight anomaly with my genetics that raises my risks of relapse somewhat(or might not risk it at all, or might mean good things, as the doctors don't really know-it's that rare.). She also said that no one can tell the future, but either way--continue chemo or have the bone marrow transplant-- the choice of either treatment is perfectly reasonable.
More or less I could just about flip a coin!
So after meeting with Dr. Baer, Diane made a list of the pros and cons (she says thank you Tillie Tompson) we had discovered about each treatment. Though I have made my decision, I wonder what all of you might do if faced with this dilemna:

Bone Marrow Transplant.
Pros:
lower chances of relapse
RPCI good at preventing infection and Graft-Vs. Host Disease (nasty side effect of transplant)
A patient with young age, and in good health.
Two donors who are already typed and match
A patient who is already adjusted to chemo and lifestyle of sickeness.

Cons: Graft-vs. Host Disease and other infections
30+ days inpatient at Roswell
100+ days in recovery with a caregiver 24/7.
high risk of complications.
risk of DEATH (even a small risk is a big deal)
Uncertain what next step is if treatment doesn't take: second BMT more risky than first.

Continuing chemotherapy through two-year maintenance- no BMT.
Pro:
A patient who is responding well to treatment
Classified as T-cell ALL, which according to research is the "best" kind to have as far as treatment goes.
Intensive treatment ends February/March.
Easier on patient, less immediate risk for patient.
Dr. Baer: for chemotherapy "The only risk is relapse". And death was NOT mentioned.
Roswell uses cutting edge chemo treatments that research studies suggest.
Good chance of finding other donors later on if need be.
Leaves option for BMT open for later date should a relapse occur.
Typed donors can be contacted again later on if needed for transplant.

Cons:
Abnormality in 9 and 10 chromosomes and smallish number of T-cell genetic indicators play uncertain role in remission rate. Not necessarily a bad thing, not necessarily a good thing. No research exists for this specific abnormality- I'm just that weird.
2nd induction chemo can be resistant, but usually the cells can be "beaten down" enough to start transplant, according to Dr. Baer.
Increased age increases risk of difficulty.
typed donors may have moved or died or gone to Iraq or whatever, meaning more tests and time to find new donors.
Potential for relapse more likely with chemo only (as opposed to with BMT as treatment).

So, uh, notice anything about these lists? They're all about the same length. So, there's pretty good support for doing either thing. I've decided to stick with the chemo now and bet my money on the disease not going into remission. The way I look at it, either treatment I choose has plusses and minuses, but at least if I save transplant for a later date, I have it in my back pocket should a remission occur. I haven't told the doctors yet, but I plan to do so later in the week.

I never liked being a gambler. What would you do if you were dealt my hand?

Matt

1 comment:

Chris Baker said...

I guess all the Wed. night poker guys could be offended by your last 2 sentences, but then I realize you're just there for our fine company, and that's cool.

I agree with your choice. If chemo is working for you now, stick with it. Like you said we can't predict the future, so stick with what works now.

Chris Baker