Friday, February 19, 2010

The 60-Day Evaluation

On Thursday 18 February we traveled to Baltimore for my 60-day stem cell transplant evaluation at Johns Hopkins. Blood, urine, and bone marrow were extracted from me for testing. Eventually, we ended up in the office of the Hopkins oncologist, for the first time since the original consultation, back in October. Apropos of this, Huong mentioned our surprise that we had not seen him during the entire course of the transplant, to which he responded that we should be glad about that, since he does not become personally involved unless something goes very seriously wrong, and the patient is at risk of imminently expiring.

The good news is that all the relevant blood chemistry and cell count numbers are in their normal ranges, or at least close enough for comfort. He cleared me both for air travel and for wine consumption. The former permission was granted with the caveat that any immunizations required for overseas travel would likely not work so soon after the transplant; the latter was of course accompanied by the usual boilerplate about not indulging to excess and so on.
The results of the bone marrow biopsy will not be available until sometime later this week.

When I questioned him regarding the efficacy of these tests, in view of the fact that they were insufficient on their own for my original diagnosis, he surprised my by saying that one major reason for doing them was to detect any remaining
chemotherapy-inspired toxicities that might have to be dealt with at this point. This was the first I had heard of this. In my case, so far, there is no evidence of any such toxicities. But with respect to my point, he didn't really seem to have much to offer (in my opinion, and also in Huong's). Prior to the transplant, one of the more esoteric blood protein measures was a bit elevated, but many patients exhibit much higher levels, and so for them any post-transplant reduction in this number would provide more reassurance than it does for me. So I am still puzzled about how exactly we know what effect the transplant had on the cancer itself. The unsatisfactory (to me) answer seems to be that we really don't know, and the path forward will be to continue testing and watching for symptoms. So what, in the end, was the justification for doing the transplant in the first place? Apparently, simply this: Statistically, patients who undergo "successful" transplants (where "successful" is defined as not killing the patient) live a few years longer than those who don't.

Another disappointment came when we talked about my damaged skeleton. He agrees that bisphosphonate therapy (i.e. Aredia) should be resumed, but he expressed skepticism that it would do anything to roll back any of the damage already done. As things stand I am at increased risk of fractures, and the Aredia will reduce that risk by strengthening the bones, but he doesn't think that it will cause new bone to grow to fill in the existing lytic lesions. This is a subject that I need to revisit with the Christiana oncologist.

I attempted to draw him out on the subject of whether or not he thought I would need long-term chemotherapeutic maintenance therapy, but he would have none of it, declaring that this was really a subject to be addressed by the Christiana oncologist, whom I will next see in March.

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