Unless everyone I encounter is a talented liar, I am forced to admit that I must look great.  At least that’s what I’m uniformly told by just about everyone who comes to visit.  Now, it’s likely that they’re really saying that I look great for someone who’s suffering from a particularly pernicious incurable disease (with common courtesy dictating that they leave out the last part).  This conclusion is reinforced by the fact that my “looks” didn’t generally warrant such positive remarks before my illness.

In any event, it’s nice to know that I don’t look like I’m sick.  Most of the time, I feel my being ill is just part of my life now, like being short or being a good athlete (ok, an acceptable athlete). After all, I much prefer to be discussing other matters (not dwelling on my infirmities) and just enjoying life. 

Nevertheless, these constant comments recall – at least in my mind – The Picture of Dorian Gray.  In this 1890 novel, Oscar Wilde tells the story of a young man (the eponymous Mr. Gray) who is given a portrait of himself that fully captures his immense beauty and vitality. Recognizing that his own beauty will fade, Dorian sells his soul to ensure that the picture, rather than himself, will age and fade. After making this deal, Dorian pursues a libertine life of hedonism and immorality. As promised in his devil’s bargain, Dorian stays young and beautiful, while his portrait ages and reflects all of his sins and his corrupted soul. Not being able to stand the horror now being depicted, Dorian tries to destroy the portrait, but in doing so, he kills himself. His body shriveling and decaying as the portrait again resumes its original state depicting him as a handsome young man.

I’m fairly sure that I don’t have a similar picture of myself stored in our attic (although Marcia wishes that I’d hide a particularly prized painting of me as a five-year-old wearing a powder blue suit that hangs in our dining room). In any event, when I examine my recent blood tests, I feel a bit like Dorian Gray did when staring at his aging portrait.  It’s not a pretty picture.  

When I last posted, I was about to undergo my first Donor Lymphocyte Infusion (“DLI”) – a procedure that transfers healthy white blood cells (lymphocytes) from my original donor to my blood. It was hoped that this infusion of healthy lymphocytes would “reboot” my stem cell transplant and help my immune system rid itself of remaining cancerous blood and stem cells.

Well, as luck would have it, the first DLI had no discernable effect whatsoever. It is possible that this was attributable mainly to the first DLI using only a small fraction of the donor’s white blood cells. The use of a small initial DLI was a necessary precaution taken to ensure that I did not have a strong adverse reaction to the donor’s white blood cells.

Editor’s Note: While I had previously received this donor’s white blood and stem cells without incident during the stem cell transplant procedure, I was also receiving powerful anti-rejection drugs at that time.  These drugs muted the negative effects of the donor’s cells to such a degree that I did not suffer any significant Graft v. Host Disease (“GvHD”).  On this go round, I would not be receiving any anti-rejection drugs.

A second (and much stronger) DLI is presently scheduled for April 25, 2024. Although there is some hope that this could have a positive effect (due to the increased amount of white blood cells) there is also some doubt based on my recent blood and bone marrow testing. At present (based on February 27, 2024 biopsy), my bone marrow now contains only 10% donor DNA. In other words, my old “mutated” DNA now makes up 90% of my stem cells.  It is clearly desirable if these percentages were reversed.

Equally discouraging, a March 28, 2024 DNA test of my blood (as opposed to my bone marrow) revealed approximately 1% donor DNA. Not optimal. On the positive side, the DNA sample isolated from the T-cell enriched fraction of peripheral blood contained approximately 93% donor DNA. As regular (and attentive) readers may recall, T-cells are a type of white blood cell that originate in the bone marrow and mature in the thymus gland. Significantly, one of the two main types of T-cells (Cytotoxic T-Cells) directly kill cancer cells by binding to them and inducing apoptosis (cell death). A desirable outcome in my case.

It needs to be stated, though, that the upcoming DLI will not provide a cure -- absent a miracle. And while miracles do occasionally occur when treating secondary AML, they sadly occur about as frequently as one could expect to win the lottery and far less likely than one could expect to be struck by lightning. On the other hand, with a little bit of luck, the DLI may possibly tamp down my leukemia sufficiently to allow me to reduce the amount of chemotherapy and significantly improve both the quality of my life as well as my longevity. Good things.

Editor’s Note: The odds of winning the Powerball jackpot are less than 1 in 300 million. The odds of being struck by lightning in one’s lifetime is about 1 in 15,000 – which is slightly more than the odds of sinking a hole in one.