Good Morning Team Zachary,

Here is a rough statement of the clinical situation as understood through our meeting in Omaha yesterday with his head oncologist, Julie Voss, M.D.

The PET Scan has indicated that Zachary's active cancer remains and is growing. When this type of lymphoma comes back after serious high dose chemo it is stronger and more resistant. It therefore becomes more difficult to treat.

As reported previously, the 'autologous' stem cell transplant Zachary received was from stem cells collected from his own body prior to the high dose chemo he received this past summer. As has been rehearsed before, the autologous stem cell transplant had absolutely nothing to do with actually curing the cancer but only with allowing Zachary to restore his immune system and recover from the high dose chemo. However, it is now clear that his immune system is not, on its own, capable of managing this cancer.

Therefore the next best option Dr. Vose is proposing is the path of an 'allogeneic' stem cell transplant. This involves receiving the stem cells collected from a donor - ideally one with a very close genetic match. The best candidates for such a genetic match are, as you might imagine, siblings, of which Zachary is blessed to have 3 potential options. If none of his siblings are a good match, then he goes into a waiting pool which can take several months to connect with an appropriate donor. This could become problematic. However, we are hopeful that he will not have to look beyond his siblings, all of whom are grateful to help.

This allogeneic stem cell transplant actually does directly, in the best of circumstances, address the capability of the body to not only recover from additional chemo but also brings in reinforcement from an alternative immune system which, hopefully, is capable of addressing the presence of cancer and sending it into remission. This is the plan.

First, however, Zachary will need to have yet another surgical biopsy in the next week(ish) to confirm the current cancer type and provide guidance regarding the next chemo recipe and regimen. After this determination, chemo will begin soon followed by the transplant program. It will be necessary for Zachary and Dara to remain in Omaha for approximately 4 months after the transplant for continuous monitoring.

Statistically, 90% of transplant patients survive beyond the 1st 90 days after the procedure. Should everything go precisely according to plan and should Zachary's body respond well to the transplant, there is a 30% chance of survival for another 5 years or potentially beyond. This is not a picnic.

Many of you have been and continue to be generous in your offering suggestions regarding other professional caregivers, institutions, alternative medical options, experimental procedures, natural approaches, herbal remedies, European research, over-the-border clinics, revolutionary concepts, mental, emotional and psychological balancing programs, non-western medicinal approaches, nutritional supplements, etc. We have been and continue to be grateful for all of the recommendations we receive every week and the love and concern these represent. Many of these options we have and continue to research. Zachary and Dara are finally the decision-makers regarding any such exploration. While many of these solutions sound very wonderful and hope-filled, we are learning that hope, like fear, can often serve to rob us of the abundance of life lived fully today.

Whatever the future statistics may be, they are mostly meaningless. What is meaningful is that it is 100% certain that Zachary is here today. It is 100% certain that he is not missing one day of enjoying the autumn sunshine. It is 100% certain that he is not missing one day of petting and interacting with his dog, Sammy. It is 100% certain that he is celebrating every walk around the neighborhood holding Dara's hand.

One of the lesson's of Zachary to our family is 'this is it!' 'There is no other moment coming.' 'Be here now'(Ram Dass). This is the great lesson Zachary continues to embody and share with all of us.

I am paying attention to this great teacher.

Much love,

Ann