Saturday, February 7, 2009

Day +11 - Engraftment!

Good news! It looks like the new baby stem cells are growing, which means we have engraftment!! Technically engraftment would have been on Day 10, but I'm still a little cautiously optimistic since I'm worried that it might be my *old* stem cells coming back from near-death and re-growing. But with doctors now thinking that the skin rash is graft vs. host and not caused by the antibiotics, and the fact that different doctors have repeatedly said that I got a pretty large bag of stem cells, they're not surprised that engraftment is happening a few days ahead of schedule. Normally it takes 2-3 weeks to engraft, and apparently mine started on Day 10. Woohoo!!! Since today is Day 11, I was still scheduled for one more day of Methotrexate chemotherapy, used to slow down the new stem cells, so the numbers might decrease slightly tomorrow. But the doctors are happy and things seem like they're off to a good start.

Check out some of the graphs I put together for the recent weeks. The first graph shows my total white blood cell counts. The green bar is the normal range, and the purple bar is when I underwent what they call "conditioning", which is the chemotherapy to prepare your body for transplant. It should really be called "total annihilation" since that's basically what happens. You can see the little white blood cells spike in numbers as they react to this toxic, foreign substance, but they quickly lose the battle. The thing that's notable is the little uplift on the bottom right, as the the new stem cells start producing new white blood cells.

Again, with the neutrophils, one of the white blood components that fight bacteria, you can see the neutrophils multiplying in numbers in anticipation of a fight, then losing all of their soldiers and dropping to 0. Literally. Neutrophils only live in the body for 6 hours, so my chart had said 0.00 for over a week. Zilch. Again, notice the little uplift on the bottom right. A neutrophil level above 0.5 is significantly safer health-wise than a level of 0, so to already be at 0.8 is huge. Granted, this will go down again after today's methotrexate chemotherapy, but it's a good sign that these new stem cells are strong!

My hemotocrit level got a boost as well yesterday. The boost before that at 24 was due to a red blood transfusion. Hematocrit is a direct correlation with how fatigued I get, since the fewer the red blood cells, the fewer the amount of oxygen that can be transported throughout my body. For example, when my hematocrit hit 20 a few months ago, I couldn't stand for more than a few minutes and fainted for the first time in my life. Red blood cells and platelets have a longer lifetime than white blood cells, which is why you don't see them die off as quickly as the white blood cells above. For red blood cells and platelets there will be a period of time when the old and new cells mingle until, eventually, the old ones die off or are attacked and eaten by the new immune system. Poor old stever blood. You did me good up to this point. It's sad to see you go.

I've had two platelet transfusions so far, as you can see in the little upticks on the right (the first uptick happened by itself), but the uptick at the end is the one that's interesting in that it also appears to be from the new stem cells.

So all blood components so far are seeing some activity. This is great news! I'm still slightly worried that these are my old stem cells coming back from being near-dead and finally coming round. But after asking that question to a bunch of doctors and nurses, they're more and more convinced this is engraftment. Besides, they tell me, "the chemo you got was lethal for a reason. If you didn't get those stem cells, you'd be getting daily transfusions just to keep you going. Your old cells didn't have a chance." I knew that all along going into this, but part of me always wants to be cautious before getting too excited.

It's also been my first full night and day with no fevers, thank god, so that's real good news. Though this could be partly due to the steroid called Prednisone that I'm now taking, which masks fevers, and will be taking for a while to help with graft vs host. The skin rash seems to be dissipating, and in general I'm feeling pretty good. Last night I was really worried since I had a lot of trouble swallowing water since my throat was swollen and filled with mucus, and there were also areas in my throat that were bleeding. As I tried to sleep I was about to write off eating food altogether, I felt so miserable, and was tempted to switch to the IV nutrition after all, as much as I didn't want to. But this morning I tried again with ice water and magically it was almost like drinking normally again. There are still a few bumps down there, but it was nothing like yesterday. So I was actually able to drink 2 of those 470 calorie milkshakes, eat a bowl of campbell's soup, and drink some gatorade and lots of water. Whew! It's possible that my counts coming up are causing the improvements, and that would be just in time, let me tell you.

My evil eyes are still dark, dark red, and the docs say it won't go away for another couple of weeks. It's totally painless, and doesn't affect my vision, but still gives me a start when I see myself in the mirror. What's eerie is that when I see them, it just looks like they're all black, since the flash of the camera is what makes it look red. So I can't even really see where my eyes are looking at. It's just a strange sight to see. I've taken some pictures, and maybe I'll make some Halloween masks for next year :)

Our friends Joe and Annie stopped by and helped me walk my 2nd mile, and they picked up food for Johanna who'd been with me most of the day, and we all had a good time chatting about random stuff.

That's about it for now. The next thing to watch for now that the engraftment has started is more graft vs host issues, like skin rashes, gut diseases, liver and organ issues, etc. It's a delicate balancing game to make sure the new stem cells have enough leeway to take over, but not to give them enough control that they might start attacking the host body, me. Since my donor is a 9/10 match, we very much expect to see more GVH issues. Roughly 50% of patients will get GVHD (my statistics are higher), and they'll usually be fully resolved in a 5 year timeframe. The other thing to remember is that my immune system does not have any learned immunity from the donor, but rather the immunity of a freshly born baby. And so, for the next year, I'll have to be very careful not to get things like the chicken pox, the measles, etc. At one year after my transplant I'll even go in for vaccinations just like a baby gets. I think of it as like installing a fresh copy of Windows XP, and than scrambling to get all the security patches and fixes installed before getting hit with a virus.

So keep your fingers crossed that these are real donor cells and that they keep going going going! We won't absolutely know for sure until Day 28, so it will be a kind of tense waiting game!


Anonymous said...

Glad to see you're doing better. We're rooting for ya'll!

Here's todays turkey news: Hoss (the big chocolate lab dog) saw the turkeys this morning from the bay window. He let out a bark and growl, which caused the turkeys to rear up and flap their big wings. He saw that and promptly sat down and looked over at me and then back at them as if to say, "it wasn't me it was his fault go after him". That Hoss is such a big wieny.
Uncle Leon

Anonymous said...

wow! Fantastic news. I love seeing the charts with the little line moving in the right direction. Congrats! You're absolutely amazing - those stem cells know they've found a good home and can't wait to settle in. :)


Jenny said...

Yeah!!! that is great news! So 4 days left on our vaca...can you ask the docs when it is safe for us to come visit? So far neither greg nor I have had any illnesses, but considering that we are coming from SE asia...what time precautions would the docs need? or can we just come over if not symptomatic?
So happy to hear that Stever's new cells are kicking in! See you soon! - Jenny

DKS said...


That's great news! Sounds like you have strong new stem cells doing their job efficiently!

Best wishes for continued quick improvement, and minimal GVHD issues!


farookh said...

wow! that's wonderful news! go fresh copy of windows xp!!

Anonymous said...

Congrats from the McLeans on engraftment!! It's a biggie!!!

Jon just had genetic testing done on his peripheral blood as part of his 4 year post transplant workup. It's still 100% donor cells, which is exactly what we wanted to hear.