[Greg H]

Marcy and I journeyed up to DukeHealth in Durham on Thursday, for my initial transplant consult with Dr. Mitchell Horwitz.

I was really impressed with Dr. Horwitz as a thoughtful, careful, studious practitioner of the art. He took plenty of time, asked lots of questions, and cheerfully fielded lots of questions from us.

The initial objective was to determine whether I am a good candidate for a bone marrow transplant. The answer is Yes. Aside from my recent pancreatitis episode, I am healthy, without comorbidities like heart disease and diabetes. And I gave up all my debilitating vices years ago.

We plan to begin the donor search immediately, with the expectation that it will take 6-8 weeks. Meanwhile, I will continue my monthly cycles of Vidaza in an attempt to drive down the blast count in my marrow. The expectation is that we will move to transplant in about ten weeks or so -- that is, around the end of June or beginning of July.

The transplant-related question that remains is the type of conditioning.

Transplant typically follows one of two paths: fully myeloablative conditioning, in which we will attempt to totally eliminate my blood production system and replace it with a new one; or reduced intensity conditioning, using drugs that are somewhat less toxic and counting on the emerging new immune system from my donor to mop up the remnants of my blood factory.

Dr. Horwitz is inclined to go with a fully myeloablative conditioning. He explained that this is more likely to be curative and to avoid relapse after transplant.

However, he indicated that he wants to do some additional research to make sure that my TERT mutation and short telomeres do not mitigate against the high-intensity conditioning.

Which option we settle on will determine how long I am in the hospital -- as opposed to being treated on an outpatient basis. The fully myeloablative conditioning is also riskier up front because the drugs involved are more toxic and the process leaves the patient with no shred of a functioning immune system.