It's coming up to the three months that Prof. Gribben at The London Clinic said we could delay transplant for before needing to review the whole situation. That process has already begun with an email from Diana the ward manager asking how I'm doing and what my plans are.
The big unknown, of course, is how the coronavirus pandemic will go. It seems clear that most of the country, and London in particular, is now past the first peak - and also that this thing is harder to catch than at first thought (outside hospital and care home environments). Nevertheless, there's a a good chance that as lockdown is lifted there will be a second wave and maybe a third after that - all at a time when the NHS will be under the usual winter pressures and possibly worse than usual winter 'flu. OTOH there's a quite impressive argument that the virus has an internal dynamic of its own that is pretty much independent of whatever measures we take against it. It starts off highly infective and dangerous to health, then gradually fades away in both respects over a period of several months.
The second aspect of the coronavirus situation is to do with the prospects of a vaccine and a treatment becoming available within the timescale of any transplant I'm likely to have. The vaccine situation is complicated by the arrival on the scene of RNA and DNA vaccines which (if I understand them correctly and I'm not 100% sure I do) do not require an immune system response and therefore should be OK for immune-compromised people, unlike many traditional vaccines. At the most optimistic level, population-level doses of a vaccine of some sort may be available by September. More realistically, I wouldn't expect it in much less than a year. As for a cure - many existing drugs have been flagged up as prospects but AFAIK none of them have lived up to early promise. So, even with the huge international effort towards finding a cure, I don't expect one soon.
Turning to my personal situation, 70 is the generally accepted upper age limit for transplant. I'm 71 already ("but you're a fit 70!" as a several haematologists etc. have told me) and if we delay for long enough for the problems above to be resolved, I'll be 72. Or even 73. That argues for going for transplant as soon as possible.
One thing we know now that we didn't back in March is how good my response to chemo has been - paraproteins still at "undetectable" and all other bloods numbers good apart from lymphocytes being just a trifle below normal range. In another week or so we'll have an idea of whether the new chemo regime is keeping things under control (and me in remission). If the answer is "yes" then I have to think about whether it makes any sense to change horses mid-stream and abandon chemo that works in favour of a transplant that might give me many years of remission but also might fail after just a few months - and I'm reading more and more cases of people whose transplants did just that.
The recovery process from transplant can be very tough. There's the first two or three weeks in hospital (nausea, diarrohea, total loss of appetite, etc.) and then maybe six months of being in a pretty bad way while the immune system rebuilds itself. As always with myeloma personal reactions vary widely, but is a bad outcome something I want to risk? After the best part of three months isolation at home I'm definitely not looking forward to the prospect of another six months isolating while feeling utterly lousy for most of the time as well.
Post-transplant monitoring will involve regular trips to London, whether I feel up to travelling or not. Something I could do without...
Finally, it's clear from everything I read online that the era of SCT being the "gold standard" treatment for many blood cancers (including myeloma) is coming to an end, as various new chemo and gene-therapy options become available. Overall, my enthusiasm for transplant is definitely waning. If not for the virus, I'm sure I have gone ahead with it in late March. Now, I'm not at all so sure.
No comments:
Post a Comment