Here is short update on my most recent blog post, following a meeting with UCSF this week. My doctor, Dr. Smith, discussed my case with the full UCSF transplant team. There are no definitive studies of my specific case of graft-versus-host-disease where donor B-cells produced in my bone marrow attack healthy blood cells and so no standard protocol for lines of defense beyond Prednisone, which seems to moderate the donor B-cells but leaves me more immunosuppressed and is only a short-term solution.

The new consensus plan is to keep monitoring my blood counts weekly and to start an oral chemotherapy drug called Methotrexate to suppress the B-cells as the Prednisone is reduced — the goal is to reduce the Prednisone (and Tracrolimus, which suppresses T-cells) to zero. I received infusions of Methotrexate in the hospital after my transplant. The UCSF consensus is that an oral supplement could moderate the B-cell attack on healthy blood cells longer-term and may avoid a splenectomy. Phew!

In the meantime, I am getting outside for daily hikes of 5 - 7 miles. I feel pretty good despite the insomnia and shaking that is inevitable on high dosages of Prednisone and the seemingly endless isolation from COVID. I will update this blog in about a month as UCSF begins to implement the new plan and, hopefully, I am vaccinated. 

All the best,

Steve