the path - part II

Previously, I went over the chemotherapy arm of my dad's treatment plan.  The second arm is the stem cell transplant (STC).  Chemotherapy is pretty straightforward.  It ain't rocket science.  STC is much more nuanced and difficult so let me try to explain it as it relates to my dad as clear as possible.

1. He may or may not undergo a STC.  Nothing is definitive in a disease like cancer.
2. The reason for preparing now is that it's a Herculean task.  Insurance approval, donor match, etc all can take months.  If and when my dad needs the option of STC, the groundwork needs to be already completed.  The window of opportunity for receiving STC can be short so it needs to be accessible when necessary
3. The best potential match is a sibling.  Sibling matches result in far, far, far fewer complications than less related or unrelated donors.  So while I greatly appreciate all the offers to donate from other family members, at this point, my dad's siblings are the way to go.  If you still feel moved to contribute medically, then I recommend that you consider registering at bethematch.org.  Who knows, perhaps you can give someone else a new lease on life.  Also, give blood on a regular basis.  Can't stress that one enough.
4. STC is risky for the recipient.  There is a 10-15% mortality rate associated with the procedure.  Primary risks are infection or a complication called Graft Versus Host (GVH) in which the new stem cells recognize the recipient as foreign and immunologically reject the patient.
5. There is minimal risk to the donor.  For sibling donors there are no surgeries, no invasive procedures, just some needle sticks.  The biggest risk is boredom since it takes about two weeks and there's a lot of waiting around.
6. The follow up after STC is even more Herculean in the number of tasks.  Because the risk of infection is immensely high, he would stay in the hospital for about a month.  After that, he'd be released but have followups about every other day.  He would need to forgo any fresh fruit or veggies.  They'd have to be cooked to kill any and all bacteria.  No working around dirt (hard pill to swallow for my dad).  No animals and lots of other restrictions for at least a year.  Regular regimen of antibiotics and antivirals along with copious amounts of hand sanitizer.
7. The disease must be somewhat stable in order for the STC to have a chance to work.  If the disease is running rampant, there is little chance the new stem cells will be able to gain a foothold.
8. With that said, STC is the second option, not the first at this point.  If the chemo doesn't work very well, then STC becomes the next option.  I know that seems to contradict Statement #5 above but treating cancer is about as clear as mud.  This is why medicine is in large part an art, and not just a science.  There are no cookbook recipes to follow.  If the chemotherapy works quite well, then most likely (again, choices are always as clear as mud with cancer) he will continue with the chemotherapy.  The literature seems to suggest that response to FCR therapy is probably the best prognostic indicator we have.

The plan for my dad then is to get 3 rounds of FCR therapy which will take about 3 months.  At that point, he will have his bone marrow sampled to see how many cancer cells are present in there.  How he feels and how he's doing will also in large part determine what happens next.  Barring an unforeseen complications (a dicey proposition with this disease), what happens next is anyone's guess.  Any questions?