Remarkably Unremarkable

June 4, 2015

Today is what the Stem Cell Transplant team calls Amy's "Birthday".

Transplants conjure up images of big cuts in someone's body, and a set of organs being placed into the hosts body to replace their non-functioning organs. In organ transplants, that is the case.

With a stem cell (bone marrow) transplants, the initial procedure is very anti-climactic. As posted, Amy is receiving cord blood because there was not a sufficient adult match found. While many SCT patients receive larger volumes (1 quart/liter) of blood containing stem cells from a related or unrelated donor, cord blood patients receive a much smaller dose. Because the dose is smaller, many (like Amy) receive 2 cord blood units. As our Dr. said babies are "small" and Amy is a "big person" so there need to be 2 cord blood units.

Amy received her first unit of cord blood today just before noon. She received her 2nd around 4pm. Very anti-climactic. Very much like a blood transfusion. The biggest difference was the chemo and radiation prior to to eradicate her bone marrow and make room for the new cells to find where the bone marrow is supposed to be and engraft. Engraftment is like ridding your lawn of weeds and waiting for the grass seeds to grow.

Because of the smaller cell dose, it generally takes longer for the stem cells to engraft. A couple of weeks is not unusual. Amy is part of a trial that uses an agent in one of the cord units to serve as a homing device for the cells so that they find where they belong a bit quicker. During this time, she will receive red blood cell and platelet transfusions. She will continue to be on immunosuppresive medications and steroids to reduce the chances and effects of graft vs. host disease. As well as antibiotic, antiviral, and antifungal drugs to keep infections away.

All transplants come with risks, and those risks are weighed with the benefits. Neutrophil, red cell, and platelet recovery generally take a bit longer with cord blood blood stem cells when compared to adult donor stem cells. The immune system generally take longer to be developed. The potential for acute and chronic graft vs. host disease can be reduced. Regardless, SCT are the best way for a cure for AML at this time.

We will be patiently waiting for the new stem cells to engraft and start producing new neutrophils...a type of white blood cell. During this time and for many months after, Amy's immune system will be that of a newborn as previously written. Once the cells engraft and make friends with her existing organs, we'll be doing our best to keep various germs away. Babies have 9 months in the womb, in their bubble. Amy is out in the real world from day 0 (today). As written before, she will receive all of her vaccines again, and those will start in about a years time (9 months + 2-3 or so months like newborns).

Me, I'll be avoiding people when possible. Even though I am exempt from wearing a mask in her room, I will probably wear a mask while in her room. I'll also be OCD about my handwashing.

Thank you to the many who have commented on Facebook and twitter. Thanks also to those who have called, texted, etc. The donations for medical expenses, cards and notes. It all matters, really, and it is all appreciated. Suffice to say, a thanks here is about all we can muster.

Christmas, New Year's, Anniversary, and now a new birthday all 'celebrated' in the hospital. We celebrated quietly with cupcakes that were a bit mangled after they rolled around in the box that was carefully placed in my backpack for my bicycle commute to the hospital.