UCSF Says . . .

Vicki had her appointment with the leukemia specialist at UCSF yesterday. UCSF has one of the top ten cancer treatment centers in the country. They have an entire ward specifically for the treament of cancers of the blood and lymph systems.

No More Chemo
The specialist recommends that Vicki not undergo additional chemotherapy. The drug she would receive is from a class of drugs called anthracyclines. There is a lifetime limit on these drugs due to their cumulative toxic effects, particularly on the heart. Between the chemo she received for breast cancer and her recent chemo for leukemia, the specialist believes she should not receive more of this particular drug.

So What's Next?
The speciliast has recommended an autologous stem cell transplantation (aw-TAH-luh-gus). Stem cells are a kind of generic cell, the Bisquick of the human body. Just like Bisquick can be made into biscuits, pancakes, or taco casserole (yuck), stem cells can develop into any type of specialized cell such as heart, brain, or blood. The basic idea of the transplant is that you kill the patient's diseased bone marrow, then give the patient her own stem cells which will grow back as healthy bone marrow.

The first stage is collection which requires a 3-4 week hospitalization. During this phase medications are administered which stimulate the bone marrow to release stem cells into the blood stream. These cells are collected and stored for later.

After the collection phase she would go home for a month.

The next phase is transplation which requires another 3-4 week hospitalization. The first step in transplantation is high dose chemotheraphy and radiation to kill the bone marrow and the diseased cells which are responsible for the leukemia. In the second step the stem cells collected in the first phase are returned to the body in a process similar to a blood transfusion. The stem cells grow back as healthy bone marrow.

Prognosis
It's a long and potentially dangerous process with risk of infection along with some pretty miserable side effects, but the prognosis is pretty good with an 80% success rate.

Decision Pending
Vicki hasn't reached a final decision on whether to proceed with this therapy. She wants to have some additional tests to find out what's going on with the breast cancer, maybe a PET scan to make sure the breast cancer hasn't returned. She will also need some tests to insure that she's a candidate for the transplant, one of which is the dreaded bone marrow biopsy.

Logistics
The treatment would be at UCSF where she would receive the best care available, but which would make it more difficult for all of us to visit as frequently and help keep her spirits up. We'll have to get creative about finding ways to deal with the more complicated logistics, but I know you smart folks are up to the challenge.