Sunday, January 1, 2012

Herd Immunity and transplant decision

Dr. STEVEN L. WEINREB is a young 52 year old board certified hematologist and oncologist with CLL who recently underwent a hematopoeitic stem cell transplant in an effort to cure his cancer.

What he wrote in his op-ed piece in the New York Times is an important variation on my mantra of us all being in this together. He argues persuasively for the value of everyone eligible getting vaccinated so that all our communities reach the critical mass, passing the threshold for "herd immunity" that protects those like us and newborn and others with weak immune systems who can not protect ourselves.

Please read and share his opinion piece as I have done. This editorial is an essential teaching especially this time of year. I am grateful that he wrote it and that the New York Times published it.

Dr. Weinreb is obviously bright and thoughtful, a big picture kind of guy, which make my musings about his particular circumstances even more intriguing.

What I find so interesting is that the doctor had chosen about three months ago a transplant as his way out of the CLL morass. Knowing none of his circumstances, I am itching to speak with him and pick his brain on why he, as did I, chose the most dangerous of all paths.

Maybe he'd disagree that a transplant is the most dangerous way to go.

I have argued that doing nothing is sometimes the most risky way to go. With a transplant, it's a 50/50 proposition that I am around in 10 years. Without it, I am waiting on a miracle.

Certainly throwing more toxic myelo- and immuno-suppressive chemo that the CLL clone has already proven it can tirelessly chew up and spit out, while our fragile marrow and immune cells take all the collateral damage is not only dangerous but foolish. A potential fatal misdirected drone attack, a self inflected wound. Too many cellular casualties from "friendly fire"can be the deciding factor in our final mortal battles.

But what if those were not his only alternatives?

Does Dr. Weinreb doubt the new miracle cures? Surely as a hematologist, he'd be ahead of the curve on the latest research on PCI-327654 and CAL 101 and GA-101 and lenalidomide and so many more. Did he see the paucity of bone marrow data and the short follow-ups and the infection risks as cautionary flags?

Had he run out of time or patience to wait for the perfect trial or to open his veins to yet another promising cocktail?

Had he been there and done that, tried one of the new pathway blockers or immune modulators and it failed?

Had he already set sail for a transplant in order to grab a new immune system and the treasure was too precious and fleeting to pass up?

Three months can be a life time in the quickly changing world of CLL research these days. Would his choice be different today?

Dr. Weinreb is sensibly not seeing patients right now, a time that I so well remember. I don't have his email address. I will try to reach him by a call to his office or an old school USPS letter, doctor to doctor and see if he might write a guest post here.

One more thing to do that was not on yesterday's to do list.

Happy New Year to all.

We are all in this together. And that is a good thing.

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Anonymous Anonymous said...

Yes, Brian, it truly is a good thing that we are all in this together. i am very grateful to look around the boat and see your brave face, arms paddling away.

I had also posted a link to the same NYT opinion piece .. I spend time in Nevada County, least vaccinated county in California. My attempts to gently persuade friends to get on the vaccination train have yielded, in some cases, upsetting results .. like "Why are you spreading such negativity?".

Finally .. what a great idea to ask the hema/onc why he chose the transplant path. As someone planning front line treatment with one of the new inhibitors, I'd love to know.

All the best to you in 2012.


January 1, 2012 at 3:56 PM  
Anonymous Anonymous said...

Dera Brian

Thanks for the kind words! I really had no choice. I relapsed 6 moths after Rituxan/ Fludarabine. I have an agressive disease, one that appears to be unresponsive to traditional therapy. We quickly found a molecular unrelated match, and i had no time to wait. The new therapies are promising, but the timing wasn't right for me. I am at day (+) 100, feeling well, no sign of GVHD. Good luck!

January 1, 2012 at 5:49 PM  
Anonymous Anonymous said...

Those are good and important questions for Dr. W. I hope you get answers and will share them. Thanks again for your blog!


CLL'er since 1994

January 2, 2012 at 10:31 AM  

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