This is the journal of “Harvey”, a chronic lymphocytic leukemia (CLL) patient, as he goes through a mini-allo (also called a reduced intensity or non-myeloablative) umbilical cord blood stem cell transplant at the University of Minnesota.

CLL is the most common form of adult leukemia in the western world. In some patients, it can be indolent and may not need much by way of treatment. Indeed, some lucky patients can “smolder” for decades without having to do anything. But for a substantial percentage of patients, it can be aggressive and stubbornly resistant to therapy. None of the chemotherapy regimens available today have the proven ability to actually cure CLL – with the exception of allogeneic stem cell transplants.

Transplant protocols are not risk-free: there is a definite risk of mortality from the transplant procedure, from a possible failure of the graft and from unpredictable infections. And then there is the risk of Graft versus Host Disease (GVHD) which can make life miserable for some patients. However, survival statistics are getting better year after year. The tremendous allure of these protocols is that they are capable of actually curing the CLL. Sourcing of stem cells from umbilical cord blood and lower intensity “mini-allo” protocols are both gaining importance in this regard, since they make it possible for many more patients to have successful transplants. We hope this journal will prove interesting and helpful to other patients who may be considering this option.

What is unique about the transplant undertaken by Harvey is that it is a planned, elective transplant. Most patients with CLL (and certain other malignancies) come to the reluctant conclusion that an allogeneic stem cell transplant is their best bet after a long treatment history with traditional approaches designed to produce long deep remissions or at least keep the cancer under control. However, with each treatment cycle, the patient pays a price in terms of toxicity to his or her system, the gradual acquisition or exacerbation of co morbidities, simple aging, and the real killer – the cancer learns to become resistant to traditional chemo/immuno therapies. Because of the substantial up-front risk of mortality physicians and patients tend to treat an allogeneic transplant as a drastic final option when nothing else seems to work, when the patient is in the grip of a rapidly expanding cancer and where there is a chance of an opportunistic infection to complicate matters. These conditions, labeled “rescue” or “salvage” transplants are what the typical transplant team sees coming out of the conventional treatment planning process. The cancer doctors have tried everything else and now they believe they have no choice but to consign the patient to the risks of mortality, GVHD and uncertain outcomes of a transplant.

However, if it is determined early in the process that a given patient will eventually need a transplant, it makes sense to plot the treatment process to optimize the chances of success in the transplant rather than try it as a last-ditch resort. The patient can then work on keeping all systems in the pink of health and keep the incidence of co morbidities to the barest minimum.

So it was with Harvey. Early on, he decided he was in line for a transplant with all the risks and limitations that implies. But he and Serena prepared for it step by step and when he was finally able to get a clean remission from his CLL, they launched the double cord mini-allo with no delay. They did a great deal of homework before they selected the University of Minnesota Medical Center, Fairview, as the transplant team with the expertise, experience and protocol that suited Harvey.

The clinical data presented are from a real patient. The patient’s identity, however, has been disguised.

The banner graphics are scenery shots of Sedona, Arizona where Harvey and Serena make their home and other select places from their family travels.