Wednesday, March 21, 2007

countdown to sgn-30 and gvd

We met Dr. van Besien and his team this morning at about 9:30.

The bone marrow biopsy came back negative. The PET-CT scan revealed one active lymph node in the mediastinum and confirmed the location of the rest of the active lymph nodes in the abdomen.

I'm scheduled to have the procedure for the insertion of a triple lumen Hickman catheter tomorrow at 11am. It is expected that this same catheter will be used for the transplant. And I was pleased to learn that I could exercise with the catheter in place.

Following the procedure I'll begin the salvage treatment. I will participate in the Phase II SGN-30 study which is in combination with the chemotherapy agents: Gemcitabine (Gemzar), Vinorelbine, and Doxorubicin (Doxil). Together this chemotherapy regimen is known as GVD or GND. I will be only the second person to participate in this study at UChicago Hospitals, however, there are other individuals taking part at other participating institutions, such as Dana Farber. Click here to learn more about the specifics of this study.

Chills and fever may occur as a consequence of the antibody SGN-30. If they do happen, they will take place in the first 24 hours most likely. The first person, however, who participated in this study at UChicago Hospitals didn't experience either, Dr. van Besien said. It's possible that I may develop mouth sores, which are one of the more common side effects of the GVD. If during the course of the treatment I develop a fever of 101.4 degrees, then it's obligatory that I call his office or go to the emergency room immediately.

The SGN-30 will be infused over 2 hours. The Navelbine takes 10 minutes. The Gemzar infuses over 30 minutes. And the Doxil takes between 30-60 minutes. With the Hickman procedure and the treatment, tomorrow will be a long day.

At the end of our meeting, I did ask him his opinion of TBI, which Dr. Castro-Malaspina told us is a part of the conditioning regimen at Sloan. He said the opinion on TBI varies in the medical community. There are some who use it and others who wouldn't use it, but as for him TBI wouldn't be a option. He doubted strongly that I, who has had radiation therapy previously, would receive it again. He mentioned Dr. Joachim
Yahalom, a radiation oncologist at Sloan, whom he said is an expert in this field. He'd know what to do, but again Dr. van Besien very much doubted that they'd give me more radiation therapy. I do remember Dr. Schuster telling me that I had maxed out radiation as an treatment option a while back. So, the question of whether TBI would be beneficial is something that we must ask Dr. Castro-Malaspina, whom I decided will lead the transplant phase of this journey.

Today after the appointment I faxed a letter to Dr. Schuster explaining to him that after much investigation I had decided to proceed with the transplant at Sloan-Kettering. I followed it up with a copy mailed to his office and since tomorrow will be very busy and long, I hope to reach him on Friday to thank him for everything in light of the outcome. My family and I have had a good relationship with him and I believe he deserves a phone call and a thank you.

The unrelated donor search will be transfered from Weill Cornell to Sloan. I contacted Sinda, the unrelated donor coordinator, at Sloan this afternoon and she will send me the necessary transfer and consent forms regarding the switch. Once she gets them back, Sloan will initiate the process to take control of the donor search and coordination.


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