Opting for a Second Transplant

I wasn't surprised that the IgA on the 17th of March was up to 667. In fact, I was relieved it wasn't higher - the velcade "maintenance therapy" must be at least partly working. Dr. Bishop at NIH outlined four options for dealing with this recurrence. The first three all involved various chemo combinations with velcade. Since my myeloma is becoming resistant to that drug it's unlikely that any of these regimens would lead to a sustained remission. So for me the fourth choice, a second stem cell transplant, another shot at a cure while I'm healthy and strong, seemed the best way to go. There will be a few differences this time around, mostly favorable. Since my bone marrow has been 100% Nancy's cells since July 2005 and I've never had any graft vs host disease (GVHD) they consider this transplant equivalent to one between identical twins, so I won't need months of pre-induction chemo and suppression of my immune system. This time they will use a myeloablative dose of Melphalan for induction just prior to the transplant. This could be tougher than the non-myeloablative induction I received last time, but should potentially wipe my marrow "clean". (Presumably some myeloma cells survived the last transplant resulting in my subsequent recurrences in April 2006 and Septemner 2007). Also, they tell me that, if everything goes well, I will be able to come home after 30 days (vs 100 last time). This time the lead time is only about 3-4 weeks: scheduling the transplant at NIH, stimulating Nancy's bone marrow with a series of shots, and "harvesting" the stem cells from her blood. So we're currently planning on early May! I canceled all the locums work I had lined up for May, June and July. Judging from last time, it will be at least 6 months before I'll be able to work again.
Other than this earthshaking news March has been a pleasant month. More great skiing all month. Mary Catherine and I made our first trip of the year in the Comanche, with the new auto pilot, to Seattle for her brother Joe's 50th birthday party. Mary Catherine stayed on for 5 more days to spend time with her parents while I flew on to Tillamook, Oregon. I had a productive week working there. Thankfully the anesthesiologist I was relieving returned in time to let me leave a day early to catch a "window" in the rainy weather to get home. By prior arrangement, the Comanche went right in for its required Annual inspection. It passed with flying colors, and is ready for our next adventure - we're spending the next two weeks rambling around the Southwest (southern California, Arizona, and Utah visiting various friends and places. Should be fun and quite a change from our snowy weather here in the Northwest.