October 19, 2010

Thank you for your prayers and notes of encouragement today. The bone marrow biopsy Bonnie endured today was painful, but necessary. She did well and should have got a sheet full of stickers to take home, but instead all she got was a very sore back side that is still tender to sit or lay on. The results of the biopsy will start to trickle in on Thursday or Friday of this week with more in-depth analyses next week and will serve as the physicians’ guide to treatment.

The lump/mass Bonnie found last week is called myeloid sarcoma which is a tumor made up of useless white blood cells called myeloblasts. Previously we described that a key element of the bone marrow transplant is Graft vs Host Disease (GVHD). A mild ongoing case of GVHD helps to keep the remaining rogue leukemia cells that are floating around in Bonnie’s body more or less contained to prohibit relapses in the leukemia. A simple explanation would be that one of these (maybe more) leukemia cells escaped through the GVHD gatekeeper and found its way to the breast tissue and the immature white blood cells formed the lump/mass.

The hope is that this is a single “localized” mass and nothing further. If that is the case, the best case scenario is radiation of the area containing the mass with the potential of a mastectomy, subject to concurrence of our team of physicians. It is our understanding that it’s a little rare for myeloid sarcoma to appear in the breast tissue, so at this point we’re not sure what the clinical treatment/trials recommend.

For now the doctors have reduced the amount of steroids and immune suppressants Bonnie is taking to allow the GVHD to flair up more than its current state. If there is something brewing in her bone marrow, an increase in GVHD may aid in settling things down. The challenge is keeping the GVHD manageable and not getting out of control. Manageable means potentially more skin rashes, mouth sores, dry mouth/eyes, fingernails deformed/cracking, etc. Out of control would be GVHD in Bonnie’s liver and/or GI tract.

Once we have a clearer picture of what lies ahead we will update this blog. So in the interim, please specifically pray that the results of the bone marrow biopsy are good, that the lump is indeed localized just to the breast tissue, that Bonnie can endure the added discomfort of the increased GVHD, that the GVHD will not get out of control, that Bonnie doesn’t experience any additional fatigue from the steroid reduction, that we will continue to be at peace through this ongoing battle and that God will continue to give us emotional strength. Thanks again for your care and concern.

Steve & Bonnie