Well, after 2 months of searching it sounds like we will be going ahead with the female/22/US donor. She is the last of the three 6/6 donors to get fully typed, and she only mismatches on a single HLA-B allele (hence the 9/10 designation).
This is pretty big news, though Johanna and I have mixed feelings about it since it's not the "perfect" 10/10 donor like we were hoping for. But, beggars can't be choosers, and the alternative would be to wait for a better match which could take years, and the doctors have repeatedly said "Steve needs to be transplanted soon."
The biggest issue with a mismatched donor are increased risks of Graft vs Host disease (GvHD), a disease in which the new immune system attacks the organs and tissues of the host body. From what I understand, about 50% of transplant recipients develop GvHD after the transplant, and in some cases it can be life-threatening. Risks of GvHD increase with mismatched donors, and also with female-to-male donors, so I'm getting a double-whammy :) In most cases it takes about 5 years of treatments to finally get rid of it. GvHD usually manifests itself as problems with the skin, eyes, mouth, liver and digestive tract. For example, mouth and throat ulcers are common, along with tear duct problems that can cause dry eyes and various kinds of skin rashes. More severe versions can cause liver damage. The drugs to treat GvHD can also cause diabetes and other problems. Exposure to sunlight can also be a big problem, since it often causes flare-ups of GvHD even after it's gone. Good thing I live where I do :) However, all of the people with GvHD have said they prefer it to the alternative, which is being dead from leukemia. Bleh.
There is a tiny silver lining to this in that *mild* cases of GvHD are actually preferred, since they give rise to what's known as graft-versus-leukemia, which is where the immune system not only attacks the host's organs and tissue but will go on the attack against any stray cancer cells as well. Research has shown that patients with mild cases of GvHD actually have better survival rates than those with no GvHD at all. So it's not all bad.
Here's an interesting webcast with more info on the subject.
In other news, my best friend from high school, Shawn, is visiting from Germany and is coming to town in a few hours! Woohoo! We haven't seen each other in more than a decade. Should be good times.
Oh, and I have another bone marrow biopsy scheduled for Monday. Fun. Hopefully it will be as interesting as the last one. :)