"Warp Speed" Ahead: Some Great but Terrifying News

(First, a quick explanatory disclaimer. As I progress through this treatment process, my understanding of exactly what we're doing to my body is always expanding. Some of the descriptions in my earlier blogs aren't as accurate as I originally thought, so if what I explain here seems to contradict any info I offered earlier it's just because I'm getting a deeper understanding of the differences between the two types of transplants.)

For days now I've been promising to share some very good news with you, and it is very good news indeed. The first three treatments of Adcetris "completely resolved" my cancer. It's gone! The final line of my PET scan report reads, "No evidence of advancing disease or recurrent disease." My body is cancer-free. When my doctor told the Adcetris drug rep...she cried. This is amazing news.

But it's news with implications. From the moment of my re-re-diagnosis, we've known that the end game was to get me in for another transplant, this time with a donor's cells. "Why?" you ask, "Your cancer is gone." Well since Adcetris is so new (released for use in August 2011) no one knows the really long term effects of it. Sure it caused me to go into remission after only 3 doses, but is it a lasting remission? No one knows. My doctor told me that if I hope to see Brynn graduate high school I need to have a transplant, and so that's what we're going to do. If we waited, and the cancer did come back, it might have developed a resistance to the Adcetris and then I would have to try harsher, less-effective drugs to prep for a transplant. We're not taking that chance (though I wonder about it a lot). We are now moving towards an allogeneic transplant at, what my doctor terms, "warp speed."

Each of those things flying by are entries on my "to-do" list.

Three potential donors were "tapped" and all three went in for the required testing to possibly "Be The Match." A few years ago donors and patients were matched based on 6 genetic markers. In recent years matching became more sophisticated and 8 genetic markers were used. Now, thanks to ever expanding technological advances, my donors and I were matched for 10 genetic markers (each additional marker increasing the likelihood of a successful transplant). Two of the tapped donors match me on all 10 markers. And they're good candidates too. The ideal donor is young and male...or if female doesn't have children. My two 10 of 10 matches are ideal. So now we're narrowing in on who, out of those two, is the very best choice. But I definitely have a donor.

There are two types of allogeneic transplants, myeloblative and non-myeloblative. The first kind (myeloblative) begins with the chemo like I got with my first transplant. It's meant to kill any trace amounts of cancer that are still around, but it the process it kills your immune system too. This was my "killer" dose of chemo. With this kind of transplant the chemo would kill you unless you received the stem cells to regrow your immune system. It turns out that this time around I'll be getting a non-myeloblative transplant, which means that the chemo they give me will be an "intermediate" dose (though still serious stuff). In this case the chemo is meant to clear out my immune system so we can install my donor's immune system. That new immune system will (ideally) recognize any future cancer growths as a problem and attack them. One serious potential complication is that the new immune system can also recognize my own body as foreign and start attacking my whole body.We're *hoping* that doesn't happen.

(graphic picture of the effects of graft vs. host disease mercifully ommitted here)

 So now things are fully in motion to get me ready for transplant. I'll go for a bone marrow biopsy next Tuesday. (OUCH!!!) Then an additional barrage of tests the Monday after that (3/19). There will be meetings with the dietitian, the psychologist, and several educators. I'll have my teeth cleaned (to reduce the risk of oral infection once the transplant is under way). And there will be loads of appointments. But then on April 11th (if all goes according to plan) I'll check into the hospital to begin the process of my second stem cell transplant.

I'll be in the hospital for longer with this transplant, and the "recovery" period after discharge ranges from 6 months to the rest of your life. I'll actually be on immuno-suppressants to try to reduce the effects of graft vs. host disease, but that means I'll be extremely vulnerable to infections. It's all a very delicate balancing act. Delicate, terrifying, but necessary. I want to see my baby girl graduate one day.