Dodging a Bullet?

Saturday - July 13, 2013

Usually, I am very quick to post an update following a visit with an oncologist; sometimes I update from the clinic waiting to check out.  But obviously this time I have delayed 2 full days. Why?  It was a smooth, professional, pleasant, and all-good-news consultation.  For example, my next MRI and PET are already scheduled for July 24 with a follow-up for "the news" on August 1st.  In addition, I had team care, meeting with both an oncology fellow and my new oncologist and hearing that they had input on my scans and records from another more senior lymphoma specialist (I do love being cared for at a teaching / research hospital).  My vomiting episodes did not raise alarm nor did they trigger a clear to-be-expected-after-chemo response; my abdomen is scanned during my PETs and they rechecked my May scan and confirmed nothing of concern was evident.  AND the team fully agreed with both my R-Hyper-CVAD protocol, the additional rounds of methotrexate, as well as Dr. Ambinder's "sit tight" decision to NOT proceed with a Bone Marrow Transplant.

And there - right there at the end of the last paragraph - is the source of my delay in posting.  I am mulling over, digesting, contemplating, the oncologist's strong affirmation that I should NOT have gotten a Bone Marrow Transplant.  He stated - quite firmly - that Hopkins, UCSF, and other (what was the adjective that he used?  top?  elite? ) cancer centers are NOT advising Bone Marrow Transplants after achieving complete response from Stage 4 DLBC lymphoma.  If I relapse then have successful salvage therapy that results in another complete response THEN a BMT would be warranted but NOT after a first remission.

Joe said that I "dodged a bullet."  A potentially fatal bullet.  I am - once again - tremendously grateful, tremendously relieved, and a little bit breathless from dodging that BMT bullet. What if a donor had been available off the BMT registry?  What if I had matched?  Aside from the lethal dangers of cancer, the mortality rate from an allo BMT procedure is 1 in 4.  Yup, 25% from the BMT itself.  And then of course there is the graft versus host issue and the possible failure to graft and subsequent loss of immunity.  Bullet dodged.  Phew.  Bad luck can be good luck, I suppose  :)