February 16, 2012


Day     Date     Treatment
-13       2/24      Rituximab 375 mg/m2
  -7       3/01      Admission to hospital and hydrate with IV fluids
  -6       3/02      Rituximab 1,000 mg/m2
  -5       3/03      Fludarabine 30 mg/m2 & Bendamustine 130 mg/m2
  -4       3/04      Fludarabine 30 mg/m2 & Bendamustine 130 mg/m2
  -3       3/05      Fludarabine 30 mg/m2 & Bendamustine 130 mg/m2
  -2       3/06      Anti-thymocyte globulin 1 mg/kg & begin Tacrolimus (daily for 6-8 months)
  -1       3/07      Anti-thymocyte globulin 1 mg/kg
   0       3/08      Stem Cell Infusion
 +1       3/09      Rituximab 1,000 mg/m2 & Methotrexate
 +3       3/11      Methotrexate
 +6       3/14      Methotrexate
 +7       3/15      Neupogen
 +8       3/16      Rituximab 1,000 mg/m2
+11      3/19      Methotrexate

In addition to these, he'll also be receiving blood transfusions as-needed (every other day or every third day depending on how he's doing).  The Rituximab he's received before and out of 5 infusions, he had an allergic reaction 2 of those 5 times.  And that was at a 375 and 500 mg/m2 dose.  The three 1,000 mg/m2 doses ought to prove interesting.  Along those lines, he'll be receiving LOTS of steroids and benadryl to temper those reactions.  He's also received the Fludarabine before but at a slightly lower dose of 25 mg/m2.  He's never received the bendamustine before.

Chemo agents
Rituximab - an antibody that is part human, part mouse which destroys B-cells, a type of white cell which is also the cancer cell in my dad
Fludarabine - it mimics a component of DNA thereby preventing rapidly dividing cells from replicating thereby killing them
Bendamustine - essentially a derivative of mustard gas which torches duplicating DNA in a different manner than Fludarabine but arriving at the same result of killing dividing cells

Anti-rejection agents
Anti-thymocyte globulin - an antibody from a rat or horse which attacks T-cells, another type of white cell which is heavily involved in immune rejection
Tacrolimus - an agent isolated from a fungus-like bacterium - Streptomyces - that's ubiquitous in the soil and when given to humans interferes with T-cell function
Methotrexate - it mimics the B vitamin folic acid which is critical in rapidly dividing cells like your white cells, by being a mimic it clogs up the system and slows down the immune system overall

Immune enhancing
Neupogen - a synthetic version of a human peptide made in the bacterium E. coli which stimulates the production of neutrophils.  It's kinda ironic on the one hand to give agents to wipe out the immune system and on the other hand give agents to boost it.  But that's the art of walking the fine line of transplant.  Too much and you wipe out the cancer but killed the patient with an infection.  Too little and you leave the immune system intact but allow the cancer to remain. 

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