Friday, March 16, 2007

response from dr. castro-malaspina

Dr. Castro-Malaspina returned my call yesterday afternoon. At Sloan he said, fludarabine, cytoxan, and TBI (total body irradiation) constitute the conditioning regimen given to someone in remission at the time of transplantation. For someone who has some residual disease left, fludarabine and melphalan make up the cocktail of choice. This latter regimen is stronger than the one given to those in remission, he told me.

He didn't address Dr. Stiff's office notes head-on, but he stated (as we know) that each cancer center has a conditioning regimen that's a little different. The regimen used at Sloan is the best in their opinion. He went on to say that the Graft vs. Hodgkin's Disease (GVHD) effect is the main player in the person achieving life-long remission not the conditioning cocktail. The conditioning regimen used is key in allowing the donors' cells to engraft, but not necessarily in the full eradication of the cancerous cells. The final destruction of the cancer is helped hopefully by an achievement of remission from the salvage chemotherapy used and then, from the GVHD caused by the donor cells. We heard a similar point at Loyola.

Ultimately, a good donor match and remission at the time of the transplant are the two most paramount things. If these two are achieved, then that's the best that one can ask for really, he stated. After that we just must hope that all goes well.

Campath, by the way, a drug that Dr. van Besien told us is used in their conditioning regimen at UChicago Hospitals was dismissed by both Drs. Castro-Malaspina and Stiff.

The results of my dad's HLA-typing were available. He matched only half of the necessary markers.


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