Tandem Transplant

A couple weeks ago, on January 31, Noelle and I met with Dr. Asch, who is one of the doctors in the BMT program. The primary purpose of the meeting (as far as we knew going into it) was to discuss the stem cell collection process. We only discussed that briefly, and then she told us there was something else we needed to talk about. Then she asked if we had ever heard of a "tandem" transplant. Noelle and I had read an article a friend had sent us a few months ago about a man with Plasma Cell Leukemia who had had a tandem transplant, though we couldn't recall all of the particulars about it. We've known all along that I would ultimately need two transplants. The plan has been to go through this first (autologous or "auto") transplant next week, wait until the cancer comes back, and then start the chemo process over again and do the donor (allogeneic or "allo") transplant. Dr. Asch said that for a few key reasons, she and the other doctors on East Eight have decided to recommend that we change the plan and do a tandem transplant. The tandem transplant process is basically doing the two transplants much closer together, and not waiting for the cancer to rear its ugly head again. Ideally, the allo transplant would be done 30 to 60 days after the auto transplant.

Now, as for the reasons they advise this...

• Waiting for the cancer to come back requires going through some chemotherapy cycles again in preparation for the allo transplant. Every time chemotherapy is introduced to a person's body, the body learns about how that chemo works and has a chance to learn how to resist it's effects on the cancer. That means that going through the chemo process again may or may not be as effective as it was the first time through. On the other hand, with the tandem transplant, the need to go through a cycle or cycles of chemotherapy before the allo transplant is eliminated, and we can go straight into the hospital, have the high-dose chemo to wipe out my marrow and move ahead full-bore.
• Another big reason to move forward with the allo transplant quickly is that we avoid the need for what is called "maintenance chemotherapy." Maintenance chemo is lower doses of one or more chemo drugs given after recovery from the transplant to help keep the cancer in remission. In my case, the drug used for Multiple Myeloma patients is Velcade. Velcade is the chemo drug that has caused the neuropathy in my feet. My doctors are still hopeful that I will be able to enjoy a full recovery from my neuropathy symptoms over time. On the other hand, those chances decrease dramatically with the administration of any more Velcade.
• Lastly, my chances for long-term survival increase with the tandem transplant. My cancer is very aggressive and carries with it a very low survival rate. Any increase in survival rate is welcome and adds a measure of hope and comfort.

I do not want to go through chemotherapy again if I can avoid it. I do not want my neuropathy to increase or get to the point of becoming incurable. I do want the best possible chance of adding as many years to my life as possible. The way I look at it is this: I died the day I received my diagnosis. Every day since October 4, 2012 is a day added to my life. Chemotherapy has added these past four and a half months to my life, but without the stem cell transplants, I will die. The auto transplant has the capacity to add a couple years to my life, but not to provide a cure of the cancer. The allo transplant, whether done sooner or later, may kill me, but it's a chance I'm willing to take for the capacity it has to provide a cure of the cancer and add several years, or perhaps even decades to my life. If receiving the auto and allo transplants close together increases my chances of reaching into the realm of decades, then it's worth giving up the possibility of having a year or two of remission with a high quality of life between transplants to get those decades. 

The decision to accept our doctors' recommendation did not come easily. Noelle and I fasted and prayed about it for over a week before feeling the Holy Ghost confirm to our hearts that it's the right thing to do. With the confidence the Lord has given us, we are moving forward in faith on this revised path. Nothing has changed with the course of action for the next several weeks. I'll still be in the hospital for 3 weeks or so, then convalesce at home for several weeks to regain my immune system and my strength. Then, likely in the second half of April, I'll go in for the second transplant. That process will be very similar to this one, with a couple days of chemo to (again) clear out all of my bone marrow, then a day of rest, then the transplant and recovery. There is a big difference in the amount of time required for the recovery, however. I'll probably need 4 to 6 weeks in the hospital, then about a year to recover sufficiently to return to work.

Yes, you read that right. I won't be able to work for the next year or so. This past Thursday, February 14th, was my last day of work for the foreseeable future. Resigning from my job was a difficult thing to do without another job waiting in the wings. I've resigned from other positions before, but it's always been for the sake of a better job. Now it's for the sake of taking care of myself. I've never before made plans to be without an income for a year. Noelle and I are working through things to make that possible. We receive a monthly stipend from Sacramento County for the four children we adopted, but we've never been in a position to have to live off of it. We thank Heaven we have it, of course. But to make things work, we'll have to cut WAY back on our monthly expenses. We paid off Noelle's Suburban with our tax return, so that will save us a good chunk of change on our monthly expenses without that car payment. Also, and this hurt...I sold my car on Friday night. After discussing it together, it made so much sense. I won't need a car for work for at least a year, and I won't really have the strength or energy to drive for the majority of that time anyway. We were only 9 months away from paying it off, but it makes no sense to pay the extra money every month for the car payment for 9 months, and the extra money or car insurance indefinitely. In addition to saving that money every month, the money we earned from the sale of the car will go a long way toward paying off some credit card accounts and eliminating those monthly payments, as well. In all, we've gone a long way this week in preparing ourselves to live without my income. There's more work to be done, but we've made a HUGE dent in our deficit.

So, that's what you need to know for now about the tandem transplant plan. As we get closer to the allo transplant, I'll write more about it, but I've found it's best to just focus on the step immediately in front of me.