A Bone Marrow Transplant?

Friday June 8th we met with a physician assistant and doctor from the bone marrow transplant team in Salt Lake. They reviewed Paul's medical history and gave him a physical checking to see if they could feel any enlarged lymph nodes. Everything was good. The doctor then talked to us about what is involved with a bone marrow transplant. It would mean going to Salt Lake for about six weeks. Some of the preliminary tests could be done here but most of it would need to be done in Salt Lake. They would first have to collect the bone marrow and test it to make sure it is clean. That takes about 2 weeks. They like to do another biopsy of the bone marrow between the 4th and 5th rounds of chemo and if it is good they may collect it at that point. The next step is to be in the hospital for about 4 weeks. They would have to give him a mega dose of chemo to kill off all the bone marrow and then they would replace it with his own marrow that they had collected. He has to stay in the hospital until his marrow gets to where it is making blood and the white and red cell counts are up. It will mostly be a matter of watching him and if anything unexpected happens they are there to take care of it. He would have to have some blood transfusions. It all sounds very complicated.

We asked the doctor how he felt about Paul receiving a bone marrow transplant. His bias was that it may not be necessary. The reason for that is that overall Paul is quite healthy although his age puts him on the higher end of those they give transplants to. That means that he is almost too old although the doctor said they had done one on an 80 year old man and he did well. They usually like to do it in younger people. Paul's tests (bone marrow, CT scans, and PET scan) have all been clear and don't show any hot spots for cancer. There is the possibility that the surgery got everything. This makes it hard to know what should be done. The doctor is going to consult with his team and with other experts across the country to see what they would recommend. Paul is mentally ready for a transplant but in many ways we hope that it will not be necessary.

The doctor said that Paul is an unusual case. The first thing is that he has been on a strict gluten free diet for 26 years and did not knowingly take in gluten. The next is that this is a very rare cancer and no one really knows how to treat it. The third thing is that apparently it was found early because most cases of this type of cancer the patient was in a lot worse shape and the cancer was farther along. For these reasons we are hoping that the bone marrow transplant will not be necessary. We pray that the doctors will be guided in what is best. I also pray that Paul will be able to receive guidance as to what is best for him to do.