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Lymphoma Living with Lymphoma

Making Cancer Treatment Decisions

Introduction

I was sitting, half dressed on an examining table, feeling a bit wobbly and staring balefully at my oncologist. He was trying to talk me out of a decision I had just announced. “Look, Brian,” he said, “you don’t need a bone marrow transplant. We can manage your disease with chemotherapy.” He was emphatic. “But this feels right for me,” I said. “Don’t you see?” He would not accede the point. “This transplant idea would be like taking a sledge hammer to crack a walnut,” he said. “It’s too much. Too risky. Let’s keep our powder dry for the time being, OK?” As it turned out, it was not exactly “OK” with me. My mind was made up. I eventually went to the Dana Farber Cancer Institute in Boston to have what was then called a “front-end” autologous bone marrow transplant.

The goal of a bone marrow transplant (BMT) is to replace a patient’s abnormal bone marrow cells with healthy ones. This is accomplished by destroying a patient’s bone marrow with full-body radiation or ultra high-dose chemotherapy and then injecting healthy bone marrow cells from either a donor (allogeneic transplantor cells from the patient himself (autologous transplant). In my case, I donated my own bone marrow, which was then chemically "purged" to get rid of cancer cells and later given back to me as part of the transplant procedure. A “front-end” procedure means that the transplantation is done at the outset of the therapy regimen rather than at a later point when one’s disease has relapsed. Typically, a BMT is done only after all other treatment methods have failed.

I had my BMT in 1990, when doing an autologous transplant as an initial treatment for low-grade lymphoma was still considered experimental. The idea was that if the transplant was performed early on, there was, theoretically, a better chance of a cure, or at least a substantial remission. I am not sure why I was so determined to follow this more risky, unorthodox course.  I had a very close and trusting relationship with my oncologist, and up to that point he had made most of the treatment decisions for my lymphoma. I just felt that a transplant had to be done, sooner or later, and I knew in my heart that it had to be then.
 

A Personal History

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