As I mentioned in my last post, my doctor was planning on presenting my case to the whole team for a group opinion on what was the best plan of action for my cancer treatment. If you are one of my Facebook friends, you may have already read that she called me this past Friday with some rather unexpected news. Paul and I have had a little more time to think, pray, and research since then, so I wanted to share some of my thoughts with you and let you know where we are since the train hit us a few days ago.
First of all, the call. Dr. H called to first check on me (so sweet) and to let me know that the team had almost unanimously voted on the DLI (Donor Lymphocyte Infusion) over the targeted therapy drug Ibrutinib. Only my Leukemia doctor had voted for the drug. The entire stem cell team had voted for the DLI.
So what’s the difference and why would they make this choice? Good question! The DLI is a much riskier treatment choice, but it is the only option that offers another chance at remission…which could buy me longer life. The drug therapy, from what I’ve read, averages about two years symptom free progression before we would have to make another decision or before I could possibly be out of options. If I wait too long to do the DLI, I may not have high enough donor counts to “boost.” I might be at the point where the only option is a second full transplant, and the mortality rate for a second transplant is not nearly as high as the first.
So it seems their thinking is to try to get my donor count back up, try to get me back into remission if at all possible, and then save the Ibrutinib as my backup plan down the road if and when I have run out of options.
Just to help folks who are curious better understand the details of a DLI, here are the basic details of how it works. They start by preparing my body with Rituximab, a monoclonal antibody that targets the CD20 antigen on normal and malignant B-cells. Then the body’s natural immune defenses are recruited to attack and kill the marked B-cells. Stem cells do not have the CD20 antigen. This allows healthy B-cells to regenerate after treatment. (This drug also helps with GvHD.) The side effects are primarily while receiving the drug and do not continue on. The nickname for it is “Shake and Bake!” I did. Probably will again. But you get over it.
For the DLI, the original donor is again harvested (if willing and available, please pray). His lymphocytes, a sub-type of the white blood cell, are infused to augment an anti-tumor immune response to ensure that the donor stem cells remain engrafted. These donated white blood cells contain cells of the immune system that can recognize and destroy cancer cells. The goal of this therapy is to induce a remission of the patient’s cancer by a process called the “graft-verses-tumor” effect (GVT). The donor T-cells can attack and control the growth of residual cancer cells providing the GVT effect. Complications, as we have discussed before, include acute and chronic GvHD…graft-versus-host disease and bone marrow aplasia, resulting in immunosuppression and susceptibility to opportunistic infections. Other than that, it sounds like a great idea!! ☺
Our main fear has been the thought of GvHD. I have dealt with mild amounts of it after my transplant, but they were able to get it under control. When you have had a dear friend die of GvHD complications, those images are forever burned into your mind and it is difficult at best to choose to subject yourself to something that could result in the same end.
Then came Sunday.
We had offered to take my mom, who has been staying with us since her trip to the ER last Tuesday, to her church yesterday. But when she woke, she was not really feeling up to getting out yet and urged us to go on to our church and let her stay at home and rest. God had a reason for me to be at Creekside yesterday. When our pastor, Dean Wood, was preparing his sermon for this week, I’m certain that he did not correlate my situation with his passage. But God did.
We have just started studying the life of David…starting with getting to know Samuel, the introduction of King Saul, and this week we met Jonathan. We looked at the map of the terrain of the area, where the enemy was in comparison to Israel, how the Philistines were completely in a position of power over the Israelites.
“Jonathan said to his young armor-bearer, ‘Come, let’s go over to the outpost of those uncircumcised fellows. Perhaps the Lord will act in our behalf. Nothing can hinder the Lord from saving, whether by many or by few.’”
1 Samuel 14:6
“Perhaps the Lord will act in our behalf. Nothing can hinder the Lord from saving!” If God has purposed the victory, nothing can thwart it! Faith takes risks.
Jonathan and his armor-bearer went toward the Philistine camp and decided that if one of them asked them to “come up” then that would be a sign from God that He was going to deliver them into their hands. They did and He did! They slaughtered twenty men before the rest became confused by God. Then the Israelites saw what was happening and came in and drove out the rest. Victory…because one man said “perhaps the Lord will act in our behalf” and acted on it.
The Lord has been acting on our behalf for the past five and a half years. He has been graciously answering yes to the prayers of many faithful family and friends. So we are going to step out in faith as Jonathan did with his words on our tongues and in our hearts…
”Perhaps the Lord will act in our behalf. If God has purposed the victory, nothing can thwart it!”
Faith takes risks.
