Friday, November 6, 2009

The End of Low-Dose Chemotherapy

This past Sunday, I took the last of the Revlimid for the fourth chemotherapy cycle; on Monday, I took the last big dose of dexamethasone for the cycle. On Tuesday, I had blood drawn for the usual battery of tests, the results of which we discussed today with the Christiana oncologist, who declared them to be "perfect". He has been in direct contact with the Hopkins oncologist, and they appear to be in agreement that I am an "attractive" candidate for stem cell transplant. He revisited the fact that my initial biopsy, run on a bone marrow sample taken from the hip, was "clean", which he takes to be an indication that the scope of the cancer is limited. I will not begin a fifth chemotherapy cycle, since the stem cell transplant process will begin in less than 28 days; it is not a good idea to interrupt a cycle in progress.

We asked the Christiana oncologist about the Hopkins oncologist's revelations regarding the evidence -- or lack thereof -- of the efficacy of stem cell transplant. He knew exactly what we were talking about: the fact that the studies justifying the procedure were done with chemotherapeutic agents no longer in use. "It's controversial", he admitted. But in the end, his position is the same as that of the Hopkins oncologist: we have to work with the tools available, which consist of stem cell transplant, and not much else. It's not unreasonable to assume that undergoing the procedure using the currently available drugs will improve my chances of survival over not doing so, since these drugs are thought to be superior to those used in the studies.

So the Christiana oncologist has turned my case over to the Hopkins oncologist for now. I do not have any more appointments scheduled with him. After the transplant, once
I have returned home, I am to call him, so that he can resume responsibility for my care from that point onward.

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