Why can't we all get along?

When I consulted the concerned and compassionate Dr. Kipps, he used all his wisdom to urge me not to have a second transplant. My wife says he was practically begging me not to go down a road he sees as fraught with unneeded and unpredictable dangers.

Will my bone marrow bounce back as quickly a second time, especially as the experienced Dr. Forman wants to hit me harder this time? Or as the clever Dr. Miklos does in Stanford, do I want to radiate nodes whose DNA is already scrambled?

Here's a scary one.

Are we sure that the reason I rejected the graft was all host issues? Are we certain it was my lack of FRC induction and lack of ATG in the conditioning protocol? Do we know that I rejected the graft because my T cells weren't soften up enough? Dr. Miklos has raised the clarion call that I would be much better served by a different donor in a round two. Dr. Kipps is on his side. He bets that I have antibodies against my first donor. There is no test for this.

This is an irreconcilable with Dr. Forman. There is no grey zone. The point may be moot. If I have a second 12 out of 12 donor match, why not go for it, but if not, and I choose the transplant route, the kind and generous Yaakov, my Israeli donor, is my only hope. Would Dr. Forman, who knows me and my HLA the best, even bother to redo the search? My second choice donor two years ago was not a good match.

Help. No way to get an answer on this one.

Should I rush into such a murky mess? Methinks not.

Fortunately, my CLL is behaving in a gentlemanly fashion these days, not being too pushy or poking into places that it is not welcome. No change in my nodes for 3 months, and a stable CBC for the most part since August. As long as I get my IVIG every fortnight that is.

Even my ITP is being less spooky. The biweekly infusions are protecting my platelets and Kipps argues that I have many options yet short of chemo, let alone a transplant. Prednisone, Danazol, Rituximab, cyclosporine A, and the new platelets growth factors mimetics. If those don't work, hit the CLL .

The bone marrow biopsy next week may be important after all. If my disease has progressed from 2.8% to say 50%, the writing is on the wall, in blood. The decision is not if, but how and and how soon to do the transplant.

If my biopsy shows, say 5% monoclonal B cell monsters, I can dally, smell the roses, and wait for the CLL geniuses to get better at keeping me alive whichever path I take.