August 30: Marrow Donors (The Part I Forgot)

I probably should not have forgotten this, but we found out today that the three possible U.S. marrow donors for me are not full matches. They won't do.

I only remembered because my sister left a note on the blog I posted this afternoon saying she didn't want to ride her bike out at Christmastime. (Very wise.) Plane ticket is no problem, Laurie Ann.

David and Laurie Ann repaying me for childhood tortures

Dr. Strickland tells me that if he does use Laurie Ann, then the chances are they'll need to do a non-myeloablative transplant. (I love using that term! Big word, very medical sounding, and I understand all the parts of it. I have just a few words like that, and there's something fun about them.)

So, okay, for those of you who don't have leukemia, lymphoma, or some other disease requiring the replacement of your bone marrow, a "non-myeloablative" transplant is one in which they don't completely wipe out (ablate) your bone marrow (myelo). Instead, they just lower my marrow enough so that the transplanted marrow can out-compete it, take its place, and create a new immune system.

They then depend on that new immune system to blot out not only what's remaining of my blood system, but also to destroy any leukemic cells it finds.

Apparently, my immune system has gotten okay with whatever warped blastic (blastic, meaning immature, not blasted, meaning something I'm mad at) blood cell multiplied itself uselessly throughout my cardiovascular system. My sister's immune system, however, should be horrified at this delinquent, juvenile blood cell—and at all its clones—and should put it to death.

Dr. Strickland explained that this is not best because the chemotherapy should be part of the cure, with the transplant dealing the final blow but being more for recovery than for cure. Myeloablative transplants are like that, but in a non-myeloablative transplant the cure is almost entirely dependent on the transplant.

The problem is that a full, intense, ablative chemotherapy combined with a transplant of marrow that is not a perfect match—thus producing a lot of graft vs. host problems—is too much for some systems to handle. Am I young and healthy enough to handle it? I'm in the debatable range, and that would be up to the transplant committee.

The question is always, what's the greatest risk?

It seemed all the more clear today that Dr. Strickland doesn't want to do the partial match from my sister. He wants to do an ablative transplant, but that requires a full match or close to a full match. For a stranger, that would be 9/10 or 10/10.

They match 6 spots on the DNA with a sibling, making sure that you have the same two genes on that spot in the DNA. With a stranger, they match 10 things, not all of which are DNA issues.

To give you an example that might help. I have brown eyes, but because brown eyes come from a dominant gene, it's possible that I have a gene for both brown eyes and blue eyes. Eye color doesn't matter for marrow transplants, but just as an example, if someone were to match me in the way required for bone marrow matches, they would not only have to have brown eyes, but they would have to have one gene for brown eyes and one for blue eyes. There's 10 issues like that, which is why you're so much more likely to find a donor in as sibling, though even then there's only about a 25% chance.

Somehow, Dr. Strickland seems confident that there are other options besides my sister.

That's weird, though. He said the team was checking cord blood, which really threw me. I asked him, "What do you mean, cord blood?"

He explained that just meant they were checking to see if other people match me.

That doesn't make any sense to me.

He's still talking about checking my two sons that are over age 18. So obviously, by "options" he does not mean that he already has an alternative donor.

I didn't feel like grilling him for hours, so I gave up.

Like everything else, they'll tell me at the last minute.

For example, on the way out today, I asked when to come back. I know I'm to come back Tuesday (next week), but I don't know what time. They checked.

The answer?

They don't know what they're giving me yet, so they'll let me know. Dr. Strickland had some definite thoughts today. He told me about them. This new plan, based on an additional medicine that treats both ALL and AML (I have symptoms of both), would have me coming in Tuesday through Friday next week to receive chemo morning and night each day, rather than Tuesday, Thursday, and Saturday as previously planned.

So once again, they'll call me at some point before Tuesday to tell me when to arrive.

For the first chemo, they called me at the last minute, and when I came in, they still didn't know what they were going to treat me with!

I don't blame them. They're figuring it out as they go, and they were right on target the first time. This is the A team ... first string ... top of the line.

So I'll wait around to hear from them.

Next stop Jacksonville, Florida for a home church conference. We're traveling with four other couples, three from Rose Creek Village and a younger couple from Memphis.

I have things to do. I know that if I don't get a donor, I'm supposed to relapse and die. If my sister is the donor, there's supposed to be dangers and a lot of problems with graft-versus-host disease.

The natural order of things is going to have to excuse me, but I'm not doing that. I have a lot of people praying for me, and I have the Word of God telling me what to do. I'm just going to go ahead and live and do whatever he says rather than worrying about all those other details. I'm very fortunate that God delegated those details to his man of the hour (at least in my life), Dr. Strickland. To me, he's as much God's choice to rule my treatment as Barack Obama is God's choice to be president of the United States of America. (Ha! I couldn't resist that. Romans 13:1-8 is every bit as true as Romans 8:28.)

So with Dr. Strickland appointed by God to succeed at making me live, I'm going about my business, helping to school my kids, writing blogs, and going to Jacksonville to meet others who either understand the church or want to understand the church so that together we can offer survival, security, social acceptance, spunk, and self-realization through the only power able to provide it.