Friday, February 27, 2015

More About Transplantation if you are interested

I was going to include this section in my previous post about resting, but I thought not everyone might want to know about this so I removed it.  I promised in an early posting to explain more about the subject, so if you want to better understand the type of cancer I have and better understand transplantation (at least a summary of my understanding of it), read on McDuff!

Multiple Myeloma (MM) is a cancer of the plasma cells.  Plasma cells normally help you fight infections, but they do a lot of other things as well.  In MM, the cancer begins to create "fake" plasma cells.  They are imposters; they look like plasma cells (unless you look really closely), but they grow faster than plasma cells and crowd important cells like red blood cells and white cells out of the bone marrow.  Not only that, but they don't do what plasma cells are supposed to do, so you start by having a series or multiple infections over time, anemia, and the other symptoms of myeloma.  Prior to the new generation of treatments that began around 2000, and which are making astounding progress, one major attempt to eliminate the cancer was to give high doses of an older chemotherapy drug called Melphalan.  This drug works by killing all rapidly dividing cells which means it would target the cancer cells.  Unfortunately, there are also other rapidly dividing cells in the body including stem cells, hair follicles, and the cells that line our mouths and digestive tracts.  Stem cells are the cells that create all of our blood cells (at least that is what the ones in the bone marrow do), so if you kill them all off, you have a serious problem -- not only do you no longer have an immune system, you are going to have trouble breathing because you no longer have red blood cells after they die off!

The solution?  Transplantation.  The kind I am going to do is called "autologous" meaning that I am my own donor.  This dramatically increases the chances of survival because there is no "transplant shock" or rejection of donor cells.  So this was the main form of treatment after initial chemotherapy reduced the cancer cells in the body.  The idea is:  remove the young stem cells before they learn to become cancer cells, then kill all remaining cancer cells in the bone marrow, and put the baby stem cells back to grow up and "re-boot" the immune system.  Simple!

This has led to a debate in the MM cancer community -- with the new drugs which work in various other ways, do we even need to do stem cell transplantation any more?  Some patients are opting not to transplant, although almost all the experts I have seen, while arguing that the effect of the new drugs need to be better understood, tend to agree that transplantation is still the major treatment at the point where I am at in my treatment.  So why is there a controversy?  Because there is very little evidence that directly compares stem cell transplantation outcomes to the new drugs.  This was the cause of much anxiety for Patricia and I as we thought through whether or not to do a transplant.  I did a lot of reading and looking for answers along with lots of prayer because transplant is a very difficult process.

When we met with the Bone Marrow Transplant team as part of this process, they showed me a study just published a few months ago that compared (in the right ways) the outcomes of transplant vs. patients who did not have a transplant.  It is important to remember that these studies are expensive and take a lot of time to do.  While the study did not do a direct comparison of the exact same drugs I have been on (Velcade, Revlimid, Dexamethasone or RVD), they did compare transplant to Melphalan, Revlimid, and Prednisone (almost the same thing as Dex), so it is the closest comparison I have seen so far.  The results showed a significant benefit for transplant patients in terms of how long they achieved remission; it also showed the importance of maintenance therapy following transplant to slow down relapse.

I don't want to pop anyone's bubble, but it is also important to realize that, at least right now, we can't cure Myeloma.  It will come back -- the question is when and how long can we live relatively free of it.  For me, the longer that time frame, the better -- the longer I can work, ensure a future for my wife and family, and the better life I can live and contribute, to help others.

This study was very important to me, and along with other considerations -- that I have not yet been ravaged by Myeloma (because we caught it early), and I am fairly young and strong -- it led me to decide to go ahead with the process.  I have had no regrets with that decision so far, although as you know, the process has not been stress free so far!  I was never promised it would be.  But my Bishop gave me a blessing as we started into the chemotherapy that while this process would not be easy or painless, it would be worth it (fighting the cancer).  I feel that I have been blessed greatly so far, and I continue to learn more about life, and to deepen my love for my wife, children, parents, and all of you.  There is more I could talk about related to this study and my thinking, so if you want to know more, let me know, but hopefully now you understand more about the transplant process, and why we  decided to go ahead with it.  I'm sure if you continue to read this blog, you'll learn more details about it!  :)

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