September 13, 2010 - Preparing for second round!

We are getting ready to go in the ring for the second time with this darn Lymphoma. This time we are taking off the gloves - no rules!!! Viking style!

Today we have spent the whole day at MD Anderson, meeting with nurses, doctors, business office, labs, vital signs people you name it we've been there!
Started off with Dr. A Alousi, who is Adrian's transplant doctor. He was really nice, soft spoken man and he told us about the options of transplant.
We have the Auto transplant where you can use your own stem cells that they harvest and clean or the Allo which means from a donor. 

Dr. A told us that there aren't a whole lot of statistics to look at when it comes to Adrian's kind of Lymphoma. Its so rare so there aren't many studies at all. Even though Lymphoma is in the top 5 of all cancers, Adrian's type makes about 3 % of that. 

He said that it's better to get going with treatment now even though he feels well right now.

 The PET scan came back positive from Friday :( :( : ( . It has increased activity in the lymph nodes in his neck and some in his chest. This is the first time that the lymph nodes has been involved. It was only his spleen that was enlarged last time and of course the 80% in his bone marrow.

 The PET scan only shows the cancer in the body not the bone marrow, the black dots are increased activity. 

When he does a PET scan he gets injected with radioactive fluid that then seeks up the cells. He stands with his hands in the air for about 20 minutes and a big donut like scanner goes around his body. The picture below is what the doctors look at. 

So the plan is.... to give Adrian chemo (something different than CHOP that he had before) - he will get two cycles in Austin at Dr. H's office. Then he will have another staging, PET, CT scan and bone marrow biopsy. If he has responded well enough to these two treatments - that meaning that the lymphoma will be gone. (when he got the CHOP - it was gone halfway through, but its standard to give 6 cycles) If it's gone, then they can go ahead and do an Auto transplant. They will then give him a third dose of the chemo and then through a port in his chest with two tubes, hook him up to a machine and harvest his healthy stem cells. That will be put in a bag and frozen until he has the transplant. 

Adrian will then be admitted to the hospital after another couple of weeks and get a fourth dose of chemo in preparation to get the transplant. 

The fourth dose will be stronger so they can wipe out everything that is in there to make room for the new cells. Afterwards he will have to stay in the hospital for a couple of weeks to make sure that he doesn't get infections and the platelets, WBC and RBC starts kicking off. 

There is no risk of the Graft vs Host (or the other way around) disease (when the body or bone marrow rejects the other) when he has this procedure. The risk of complications of the actual Auto transplant is less than 5%. 

But, the risk with the Auto transplant is that the cancer can come back. We have a 50% chance of winning this round with Auto transplant. These odds would have been better if the cancer didn't come back so quickly. Dr. A said that the longer you are in remission the smaller is the chance of relapse.

After meeting with Dr. A we met up with a transplant coordinator - she went through some papers and then it was off to the Business center... 

Now, we know for example that the Neulasta shot is about $10 000 a pop and each chemo session around $12 000. See if you can just have a guess how much an Auto transplant would cost? ... our insurance company should be happy this is about half of what an Allo transplant cost...

Auto Transplant:

Evaluation $7500

Harvest cells $20 000

Transplant $100 000 

Hospital care $16 500

Mobilization $60 000

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           $ 244 000

The last visit was with Dr. Fayad. He is the one that showed us the picture of the PET scan and he talked about different types of chemo. He wants to look at the slides that we brought with us today and then make sure that it really is Lymphoma/Hystiocytes. If they are negative, then he will do a biopsy of the lymph nodes to see what is going on there. If positive then it's time to start chemo. 

I told Adrian that maybe maybe there will be a  miracle and it shows out that someone spilled pizza or ketchup on the slides and that is what is showing up. I will keep on hoping until Pathology comes back with the report. 

On Wednesday Dr Fayad will present Adrian's case to the panel - that is in front of all the Lymphoma doctors and they will discuss which chemo will be best for him and if he should get anything else. So I hope that on Wednesday or Thursday we will have the exact timeline and game plan.