It was a very interesting appointment with Dr Huebsch yesterday. First, they do have a compatible donor for Eric. Second, Eric's disease burden remains very low. His scans look great, his blood counts are good and he continues to be healthy.
Unfortunately, even with the Hodgkins in check, his bone marrow is not healthy and this seems to be why they have not be able to collect stem cells for an auto transplant. They really don't know why his marrow is this bad. It could be from the Hodgkins or the chemo that has been used to kill the disease. While unlikely, it could even be a pre-existing or congenital condition. They have tested his marrow and ruled out leukemia, other lymphomas etc. The team has consulted and reviewed scientific data in depth and there is really no data to help make a decision on what will work for a 21 year old with Hodgkins and marrow this unhealthy. It's a puzzle that he is as healthy as he is.
It seems a certainty that the Hodge will return to the bone marrow unless we can get some healthy marrow in there. The hope is that healthy donor marrow will be able to attack any new Hodgkins cells that appear in the future. This is a new idea for Lymphoma and I have not been able to find studies proving the graft vs Lymphoma effect for Hodgkins. It is a known effect for Leukemia patients and who knows -- Eric may be part of the proof that there is a graft vs Lymphoma effect too.
So, we build on the good stuff. Eric is healthy and his disease is very sensitive to chemo. That's good. It means that we can get rid of the Hodgkins, but he needs help keeping the Hodgkins from returning. All agree that an allogeneic (donor) transplant gives Eric the best chance to kill this once and for all. We understand that this is a risky procedure (just as with any other organ transplant) and that our goal is not for good health in 2008 (recovery will be in phases) but for good health in 2010 and 2020.
The question is when the best time to do the transplant is. There is some work to do with the donor to better establish how to manage the risks of the transplant. The team wants to know as much as they can about the donor to best prepare Eric's body to accept the transplant. I was surprised to learn how individualized the preparation and risk management for an Allo transplant can be. We are likely looking at an August date for the transplant.
Once again I came away from this appointment with great respect for the knowledge and experience that this BMT team has. I can't tell you how important it is to understand their level of experience and have confidence in that.
So, we have time to enjoy summer! Eric is strong, happy and we all know that he can take this on and win!
