Thursday, January 22, 2009

"Tell me great hero, but please make it brief" Bob Dylan

I need to be  brief.

Tomorrow I am presenting to the local oncologists on what I took to be the most influential and exciting abstracts from the ASH meeting last month in San Francisco.

It is quite an privilege for me, a family doctor to get to lecture to his specialists colleagues. And even though they are all kind spirited, and I can be a bit cocky, the prospect is still intimidating. I am preparing carefully. For nearly every article I want to open for discussion with the group, I have a few more to compare and contrast. 

I so want to help them help their patients with CLL, and since my whole focus is on that single topic (well to be honest, also on transplants and ITP) I can tune out the thousands of other abstracts from ASH and dig deeper into the new stuff on CLL.

Over the next  few weeks I will review some of my thinking on what a few of the critical papers mean. For a few dear friends nearing decisions, these are not "abstract"  but will inform those difficult choices with the cold facts.

I saw Dr. Forman today.  The bone marrow biopsy (BMB) will soon be scheduled in about a month, the CT is on the calendar for Feb. 27. and my follow up appointments are in early March. 

For Dr. Forman, a donor leucocyte infusion (DLI) isn't even on the table. It's chemo, then transplant. I can find no medical literature on second allo-transplants in CLL. And I am info junkie as you well know. Dr. F. sees no chance for a bounce in my donor cells. He has never seen it recover from 0%. Bummer. But I could still have a very durable remission, even with me rejecting the graft.  The longer I stay minimal residual disease (MRD) negative, the better the chances that the brief flurry of donor T cell activity affected a cure.

Wouldn't that be great! I am hopeful. But sadly that is not a plan. The CT and BMB are the plan. And then crunch time if anything shows. 

Or not. I am betting I'll still be in CR (complete remission), MRD negative 
 
Back to my abstracts.

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1 Comments:

Blogger Dragon Slayer said...

Brian
I know your BMB will show MRD negative. You've inspired many and presenting at a group of Dr's should be a piece if cake for you. Good luck!
Wanda

January 23, 2009 at 8:34 AM  

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