Saturday, day 1 of 11 of chemo.

The good news is that the test all show that I still have 95%+ of chimerism. This means that the donor cells are doing their job, engrafting in the marrow and producing effective white blood cells. The planned Donor lymphocyte infusion (which I have been mistakingly calling a T-cell infusion) has a good chance at helping out the donor cells fight the lymphoma.

The bad news is that my lymphoma has mostly recovered from the chemo that we gave it last year. My spleen has not grown huge again, but there are high lymphoma counts in my blood and in my "soft tissue". I think that soft tissue in this context is muscles, tendons, and ligaments. The CT scan shows numerous lymph nodes that are trying to sequester the disease. It does not appear to be in my bones, lungs, or other organs.

So, in order to give my DLI (Donor lymphocyte infusion) a better chance, we are going to hit the lymphoma with a low does of chemotherapy. The chemo drugs that I am taking are: Velcade, Rituxan, and Bendamustine. These have the benefit of being harder on the lymphoma than they will be to my new donor cells, and more importantly the stroma - which is the honeycomb structure in your bone marrow where your stem cells live.

I had my first round of chemo today, and it went very well. I have often had reactions to Rituxan in the past, but I did not have any problem this time. In fact, the drug that I took that had the most adverse reaction was Benadryl, which they gave me to ease my reaction to Rituxan. I guess it worked, so it was worth it, but I was in a fog all morning. I was trying to get out an email, and found that my brain had apparently turned off and I had a couple paragraphs consisting of nothing by the letter "n".

The other chemo drugs also went well today, with no noticeable adverse reactions.

The analogy that I have using to think about this latest round of care is from some alternate history of WWII. Where my body is Europe and the lymphoma are Nazi zombies (because they are undead B-cells; B-cells are not supposed to be able to reproduce on their own, without bone marrow stem cells), and my old immune system was the French, with their Maginot line.

I know that people mock it, but it was such a good defense that the Nazis did not even try to attack it, but instead snuck around through Belgium. I compare that to the betrayal of my own B-cells to become lymphoma cells and become invisible to any good B-cells that I might have had left. The donor cells are the British. They need more time before they get strong, and so are not able to help out the other besieged counties. They also might accidentally attack a county that they are supposed to be allied with (Graft vs Host Disease). The DLI is like the Americans. They come in way behind the time that they are needed, but with serious force. They work with the British to plan D-Day, re-take Normandy and beat the Nazis back to Berlin. Then they are done and mostly leave, leaving Europe in bad shape, but still existing.

So in this analogy, the chemo is like carpet bombing. It is hurting the Nazis more than the Brits, but there is a lot of collateral damage on both sides. It does buy time for the D-Day invasion, and it helps even the playing field between the mass-production of the Nazi war machine and the relatively green British troops.

I also like this analogy, because there have been no relapses of the zombie Nazis. Sure, there have been some minor wars in Europe since then, but nothing that threatens to make Europe as we know it cease to exist.
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Pam brought over a turnip casserole, swiss chard, and salad greens. Delicious. So far, the only thing that I have eaten from the DHMC during my stay here are salt, pepper, 2 hard-boiled eggs (how do you even get the inside of a hard-boiled egg that green?), milk, sugar, and bottled water. They did get me a fridge and containers of Brown Cow, full cream, blueberry yogurt. I am planning to have the yogurt for breakfast. At least in my analogy I am not stuck with MREs, and other fun war foods.

Becky is staying at our friends Peter and Brita tonight. She slept in the hospital the last two nights, on a cot that they brought in for her. She is planning on taking a relaxing morning and won't be coming by until the afternoon. It is important for her to get some rest and have a day where she is not bombarded by hospital stuff. I hope that I can convince her to do it more often, but of course, when she is away, she worries about me, probably just as much.

Leif