Mission Accomplished

All went smoothly for JoAnne today. They were able to perform the biopsy via a bronchoscope and a needle biopsy. The mass the doctors are interested in resides at the spot where the airway divides to each lung. They dropped a scope down the hatch and maneuvered a needle through the side of the airway into the mass. Then they cut and sucked samples out with the apparatus. A pathologist was present in the room to verify the samples were adequate. If they weren't, Plan B was to make an incision under the Adam's Apple and perform a mediastinoscopy. As mentioned previously, there was much conservatism on the part of the surgeons as JoJo's platelets have been weak thus increasing bleeding risk, and her immune system is weak increasing infection risk. The less invasive the procedure the better.

Preliminary indications are that the mass was infectious as opposed to lymphoma. Information gleaned from the biopsy will go a long ways towards determining the treatment path forward. It will take a few days for the cultures to grow and identify the type of infection so that they can zero in on antibiotics. It may also allow them to remove some powerful antibiotics they are using that may not be effective.

As far as the lymphoma, we do know that there are still some cancer cells in JoAnne's bone marrow. Her 100 day bone marrow biopsy was performed at Day 93 because of her current circumstances and the need to figure out how to treat her. Prior to transplant, her bone marrow was comprised of 90% Chronic Lymphocytic Leukemia (CLL) cells. At Day 28 post transplant, she was 12% CLL and at Day 93 she was 4%. A considerable improvement, although we are not sure what this means. Dr. Brunstein indicated that it didn't matter whether it was 4, 12 or 20; only that it meant there was still work to be done. The presence of mother cells for platelet production was confirmed so the answer to JoJo's weak platelet levels remains a mystery. Perhaps it is infection related.

Upon this news, we were initially disappointed and concerned. I think we had somehow convinced ourselves that all the cancer should be gone at 100 days. Plus, there was/is the possibility that the biopsied node size increase was a recurrence of the CLL. In any event, if it is determined that more effort is required against the CLL, they will reduce the anti-rejection drugs. These tend to act as a mood altering substance for the donor cells. If you want them angrier and attacking the cancer harder, you withdraw some of the anti-rejection. The risk of graft vs host disease increases, but that is the delicate balancing act.

We will be getting pieces of information over the next few days. JoJo came through the biopsy with hardly any side effects other than hoarseness. She desperately wants to go home. It all depends on IV antibiotic needs. Please pray that she be blessed with abundant patience. Thanks to all for your support and prayers.

Cancer Sucks