Wednesday, March 14, 2007

where will I be transplanted?

I'm not sure. I'm just not sure yet. I'm torn between Loyola and Sloan-Kettering.

Of the different transplant doctors whom I've met, I was most impressed by Dr. Stiff. His presentation was so compelling that I left his office contemplating having the transplant done there. His seemingly comprehensive understanding of my peculiar situation stood out to both Su and me. He gave us his opinion on some of the conditioning regimens used at other cancer centers. His argument seemed persuasive but what do I know? I am not a doctor.

My ambivalence is worsened by the fact that the conditioning regimen which Dr. Castro-Malaspina said is used at Sloan Dr. Stiff told us wasn't in his opinion effective. Indeed, Dr. Castro-Malaspina cited cure statistics comparable to Loyola and this too must be taken into account. Yes, the centers' regimens may differ but if Sloan has success numbers akin to Loyola then that must mean something too. And Dr. Schuster wasn't able to provide us with a specific regimen. It could be this or it could be that. He said it depended on the status of the cancer prior to transplantation. That I must say was disappointing considering how detailed the various doctors whom we have seen have been, Clare, Su and I think that Dr. Schuster doesn't really like to give specifics unless pressed. As Clare said, he seems to prefer explaining things in "broad strokes." By itself, I think there's nothing wrong with that. That may work well for other individuals and perhaps in other situations. However, after talking to numerous doctors who have been so specific, I find his more generalized approach too just flat.

Of course, being at Sloan would eliminate the logistical and financial costs associated with a transplantation away from home. Sloan is a stellar cancer institution. It's arguably the best in the country and perhaps the best in the world, but my ambivalence at the moment is not a consequence of my opinion of the institutions themselves but rather my impression of the specialists whom I've met and their proposed regimens.

One of the most challenging aspects of shopping for a cancer center is that the conditioning regimens differ from institution to institution and as Dr. van Besien said there is no silver bullet. Regimens will differ from place to place. There is no iron-clad, battle hardened conditioning regimen. In short, there's no consensus. That makes it challenging. In addition, I'm no doctor. How do I know what regimen is best when one specialist says this and another says that and they can provide these various stats to show this or that. All of this is a gray area.

Everyone does agree that the quality of the donor and state of the cancer at the time of transplantation are critical elements to a successful transplant. If a good quality donor is found and the cancer is in remission, all I can hope for I guess is that that will be enough to get the job done regardless of the conditioning regimen used.

I left a message for Dr. Stiff telling him that I'd like to talk to him about what Dr. Castro-Malaspina proposed. I don't plan to make a final decision about Loyola, Sloan, or even Weill Cornell until discussing this with him.


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