Hola!

Shelley and Dave are married and it was a wonderful week in Punta Cana - sun, sand and family. It was a nice relaxing week for Cor and I. But we all missed Eric and Morgan terribly. I can't wait to plan a family vacation for all of us. A week away and I am fully charged and ready to help Eric through the next transplant. Yes, transplant #2 is scheduled.

Last Wednesday we found out that our wonderful donor has agreed to donate again (marrow, so this means surgery for her/him). I now fully understand the need for anonymity - how could I ever begin to repay this person for their generosity - not just once but twice. To all of you who have been able to join the bone marrow donor registry, please accept my grateful and humble thanks - any of you could be saving someone's life.

So Eric started conditioning chemo on Saturday and the transplant is scheduled for Thursday. This round of chemo will be milder (I guess there is not much to kill off) and will be augmented with Campath. As I understand it (and I haven't talked to the doctors yet), this drug will help to reduce the T cells. I also think this drug will eliminate the need for plasma pharesis (which Eric hated).

He'll also be inpatient for this transplant because he has so recently experienced fevers (no infection found despite a robust series of tests). While the outpatient transplant option is great and I feel that it worked well for Eric in August, I think we are both relieved to be inpatient this time. As well as the recent fevers and the fact that this is a second transplant in 4 months, the winter season is here and a snow or ice storm could make a daily commute to the hospital close to impossible. This combination of risks cannot be ignored or mitigated.

As always, your prayers, positive thoughts and blog comments are truly appreciated and welcome.

Day - 9

Eric had his first infusion of conditioning chemo today (Fludarabine 30mg/m2 for you avid Googlers or PubMed afficionados). The purpose of this drug is to clean out his bone marrow and 'make room' for the donor marrow next week. This drug is not expected to have too many nasty side effects but Eric has a good supply of drugs to help counteract any minor nausea. Of course, any minor nausea could also be caused by the lunch at McDonalds.

As we expected, the chemo was quick but the paperwork was long and painful. The idea is that by completing all the admission work today, it will be quicker and simpler when/if Eric needs to stay as an overnight inpatient. I know Eric would love to complete this transplant outpatient, but Mom is sure glad there is a contingency plan in place...


That's it for today - may the next 6 weeks be similarly boring!

So, What Is Happening?

Over the past couple of months, there has been considerable testing of both Eric and his donor. The BMT team needs to know as much as possible about both so that they can orchestrate the transplant in such a way that Eric's body will accept the new marrow. Fortunately, we have a perfect match. A transplant using a matched unrelated donor is often referred to as a MUD transplant.

Eric is currently healthy -- his Hodgkins Lymphoma is as reduced as the doctor's can possibly tell. Eric's Hodgkins does not present with palpable lumps or any outward signal that it has returned. He has a couple of nodes in his abdomen that enlarge slightly (by millimeters) and then the Hodgkins seems to go right to his bone marrow. So the first indication of further relapse is low blood counts or weight loss. Currently those nodes are stable, his blood counts are high and he is at a great weight. All good signs to proceed to a transplant.

Eric will have what is called a mini or allo-lite or RIC (reduced intensity conditioning) Allogeneic transplant (or if you are googling it -- nonmyeloablative allogeneic stem cell transplant). The reduced intensity conditioning chemo reduces some of the risk around an allo transplant. Allo transplants are seldom utilized for Hodgkins due to this risk. There are no studies to support the suspicion that a mini-allo can exploit the host vs lymphoma effect -- meaning that the engrafted donor's marrow can fight any lingering Hodgkins cells.

No studies, does not mean it is not happening! Obviously, the risk around this procedure precludes random blind trials. What we know is that Eric is an excellent candidate, the match is great and we are working with the best team I could imagine.


Click to enlarge this diagram: