Warning: Lots of medical jargon ahead.
February 23, 2022 marked 6 months post stem cell transplant. As many of you know from social media, my 6 month pet-scan showed "no evidence of disease, NED!" This is really fantastic news! Here is what else I learned from this visit.
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Progress notes from visit with Cedar Sinai Oncologist 2.21.22
In doctor speak.....
Today is day +182.
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| Just a few tests... |
• Day +180 PET/CT reviewed in detail with her today. Findings consistent with CR (complete response).
• She has now recovered from her transplant and has resumed care with her primary oncologist Dr. Nguyen.
• Today we again discussed rituximab maintenance. It's unclear that she would benefit from this as she progressed on a rituximab containing regimen and only achieved a remission after an obinutuzumab containing regimen; there are no great data regarding obinutuzumab maintenance after transplant. The additional consideration is the risk/beneift balance of prolonged anti-CD20 therapy in the setting of the covid pandemic. Therefore, given the potential risk and unclear benefit we have decided against rituximab maintenance.
Plan to start post-transplant vaccines at this time. She says that she would prefer to get them done with her PCP and has already confirmed that this could be done. Therefore, I have provided her with a detailed vaccine schedule.
She received the covid vaccine on 3/20/21, 4/22/21, 12/3/21, 1/5/22, and 2/3/22.
I have checked spike protein antibodies today and they are undetectable. Therefore, will arrange for Evusheld infusion.
RTC (return to Clinic): 6 months with PET/CT for 1 year visit - August 23, 2022
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Let me translate...
1. I don't have to go back to Cedar Sinai for 6 months (at the 1 year mark) for another pet-scan. Then I will continue to get pet-scans every 6 months, indefinitely - good times.
2. I am recovered from SCT!! Yay!
3. I will continue to see local oncologist every 4 weeks to check blood counts.
4. We will NOT do maintenance therapy because we tried that and it didn't fucking work. LOL.
5. I got a 36 month long schedule for repeating my childhood vaccinations! Woot woot.
6. I received FIVE doses of the covid vaccine over the course of a year - there are ZERO antibodies detected! WTF. Basically, since my immune system was wiped out from the high dose chemotherapy pre-transplant, and now it is super young and apparently not mature enough (kind of like me 😆) to know what to do with a complicated vaccine, it leaves me with no immune response to the vax. Which means, I have absolutely no protection from covid.
The great news, I think, is that I have been approved for Evusheld. This is an investigational medication that has an EUA approval from the FDA (thus the "great news, I think" part). Evusheld is made up of two monoclonal antibodies that mimic the immune systems's ability to fight off harmful pathogens. Tixagevimab and cilgavimab (really?? who comes up with these names) are long-acting monoclonal antibodies that are specifically directed against the spike protein of SARS-COV-2, designed to block the virus' attachment and entry into human cells. Science is amazing!
On March 10th (yes approved and scheduled), I will get two injections - one in each buttocks - again, really? and thank you... did they have to find the biggest muscles in my body. This will act as a pre-exposure prophylaxis (prevention) of Covid.
March 14th - I can return to the world. I can return to work IRL!! I will continue to wear a mask and social distance. But I can start living again - co-mingling with people. No super spreader events...but this is all GREAT news. All food restrictions also lifted.
Fun Fact. March 17, 2022 would have marked two years of working from home. I am so ready to be back in the office! I love my house and my dogs and I will love coming home to both each day. But I need people. 2022 has not disappointed. We are counting on that for the next 10 months too!
Next post. A New Perspective.
