Tuesday, June 26, 2007

6/25 appointment

We met Dr. Castro-Malaspina at Sloan-Kettering yesterday. This was our first meeting with him since March when I had a consultation with him for the first time. While waiting for him, it dawned upon me that Sloan-Kettering is the fourth cancer center-hospital that I've dealt with during this almost four year war with Hodgkin's Disease. I went to Montefiore Medical Center when I was first diagnosed, then Weill Cornell-New York Presbyterian Hospital after the first relapse, then the University of Chicago Hospitals most recently in order to get back into remission, and finally Memorial Sloan-Kettering where I'm preparing for a mini (non-myeloablative) transplant. This list just hit home the long, protractive nature of this ongoing war.

My WBC count shot up to 4.7. I'm no longer neutropenic. The nurse, (Ally) Allison, was surprised by how quickly it went up from Friday. The oral irritations seem to have gone away. My mouth feels so much better. I can eat without any real issues right now.

Dr. Castro-Malaspina said I'm in a good position. I'm in remission, which is the ideal situation when undergoing transplantation. All the elements needed to prepare for transplantation are set except for the identification of the donor. We learned that the three 8/10 unrelated donor matches were not sufficient for transplantation. There were too many mismatches on the allele level. He's waiting for the analysis of the blood sample from the last potential unrelated donor (6/6), whose sample is in the lab and should be available by the end of this week. It's believed that this person will be a 9/10 match after the final analysis which will be my best bet with regards to an unrelated adult donor. However, if this person is determined to not be good enough of a match then there's cord blood. Two cords have been found and identified. One is a 5/6 match whereas the other is a 4/6. These are the best ones available. They are also looking for backups in the event of engraftment failure. Less GVHD is associated with cord blood.

He wants to move quickly, especially if cord blood is used. It's best if I'm still immunosuppressed when I begin the treatment than for my immune system to recover following the last cycle of SGN-30/GND (GVD), because it might begin to attack the donor cells which could complicate the transplantation. So, if my immune system is weaker, the engraftment of the donor cells will be easier.

We didn't discuss the specifics of the treatment that would be given to me. Once the donor has been identified, then we'll get into that. In the meantime, he wants me to lose 5lbs, especially if cord blood is used because the amount of cord blood needed is relative to the patient's weight. The heavier the patient, the more stem cells that are needed. Since the amount of cord blood available is significantly less than that which would be provided by an adult donor, the weight of the patient is much more significant than when an adult donor is used.

Tomorrow I am scheduled to see one of Sloan's dentists, who will evaluate my mouth for transplantation. Then, granted the analysis of the blood of the unrelated donor is available by the end of this week, I am scheduled to see Dr. Castro-Malaspina again on July 2nd at 11:30am for discussion of the results and future scheduling. On July 3rd, I will go for a PET-CT scan.

I also received a summons to report for jury duty on July 8th. Dr. Castro-Malaspina's secretary, Margaret, wrote a letter excusing me from reporting, which will be available for pickup when I see him on Monday.


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