Crossing the Rubicon

Day 112

In 49 BC Julius Caesar lead his legions across the Rubicon river which defined the boarder between Gaul and the Roman Republic. An action which was illegal under Roman law and could have cost Caesar everything and destroyed the Republic along with him. However, his risky course of action would ultimately change the course of history.

The phrase "crossing the Rubicon" has survived to this day and describes just the sort of calculated risk that Caesar undertook more than 2000 years ago. We might understand it better by thinking of it as the "point of no return". Which is exactly what Ann and I passed through today.


Today Ann singed her paper work to begin the Cord Blood Transplant. There is no more time for doubts and second guessing now. The process has started to move forward with a frightening pace and we are committed.

First up today we got the results of some of the tests Ann took the other day. Her latest Bone Marrow Aspiration come back with 1% blast cells. Thats down from the 3% that where in her last BMA. PCR and FISH tests have not been completed on this one, but our leukemia Doctor believes that because the volume of blast cells is so low and well in the normal range, so they are probably not leukemic. We will get those portions of the tests later.

However at this point it hardly matters. The conditioning regime pre-transplant is going to be Fludarabine, Melphaian, Rabbit ATG and Thiotepa. Fludarabine is derived from phosphonic acid, while Melphalan is derived from Phosgene! I worked a couple of jobs at chem plants in BR that processed Phosgene, and have talked to enough people exposed to it for it to be one of those chemicals that just scares me silly. To put it in perspective, Phosgene is closely related to the same infamous Mustard Gas that was used in WWI!

Rabbit ATG is a gene therapy drug composed of rabbit antibodies that have been "trained" to kill off human immune cells. Finally is the one we got the biggest warning about, Thiotepa. Thiotepa is another phosphonic acid derivative, but it will leach out of the skin after infusion and cause burns. So Ann has been advised to take multiple showers during the day after the infusion of it begins. All of these drugs will take all of her existing bone marrow and any remaining cancer cells and wipe them out completely.

The results of the CAT scan she took yesterday shows no sign of sinusitis or tumor cells in her head or neck. Thats just another confirmation that it looks like the leukemia has not been able to move into her central nervous system. Also Ann's Echocardiogram continues to show that her heart is normal and healthy. I'm unbelievably grateful for both of these results going into the transplant.

Last but not least on the lineup of today's test results was the CBC. Ann's WBC count has stabilized at 5.3 K/uL which is right in the middle of the normal range. Her platelets are at 174 K/uL (low end of normal). However her RBC count is still low at 3.05 M/uL (normal 4.00 - 5.50 M/uL), and the Hemoglobin (9.6 G/dL) and Hematocrit (27%) numbers are low along with it. I have been reassured that this is not unusual and it will take a long time for the RBC numbers to recover.

So after covering all those results I would like to introduce everyone to Ann's transplant Doctor. His name is Dr. Alousi and he is a very soft spoken and laid back man. His mannerisms immediately put you at ease, which is high praise considering the anxiety that most patients and caregivers must feel about transplants. He was very animated today and seemed genuinely excited to have all the papers and consents signed so that he could begin treating Ann.

Our next step is Apheresis, and a backup stem cell harvest from Ann in case something goes wrong with the cord stem cells. Although Dr. Alousi did tell us that because of the amount of chemo that Ann has gone through the chances of being able to harvest her stem cells for a backup is 50-50. We may have to call her Mother in Slidell and ask her to donate considering she has half of the 10 HLA proteins that Ann's cells have. Half isn't great, but it is better than nothing if Ann's cells won't cooperate.

I know everyone wants to know exactly when the transplant will be. However, MDA still has to coordinate a few more things before they can tell us. We expect that we will be getting a call this afternoon or tomorrow letting us know exactly when.

More updates later if we need to.