Visitation, good days and bad days, and how transplant donors are matched

 

So today (Wednesday) was a tougher day.   While the hair is still firmly attached, the clock is ticking.  Nausea waves slosh around and the focus is fading.  Chemo doing what chemo does.  It’s tough.  She’s been there before, knows what’s coming, and still, when I chatted with her for a few minutes, she seemed to be pretty positive.  But it comes and goes in waves.

Shannon was with her much of the day getting paperwork done.  Greg was going to bring some soup.  Julia Cain (jula.cain@gmail.com) (both spellings are correct) has set up the protocol for visitations.  Ping Julia via email and she’ll send you a calendar app were visits can be coordinated.  There’s a feature of the calendar noting good days and bad days.  Life is imperfect.

So now for a little history and some good news:  The donor matching process……

Matching patients to donors is complex and has come a long way since Kristina’s first transplant back in 2007.  The process is far more than simply matching blood types.  The match is made based on HLA (human leukocyte antigen) tissue types.  We all have HLA proteins and they act as markers within most cells in our body.  Our immune systems uses these markers to recognize which cells belong in your body vs those that do not. 

When the immune system yells ‘friend or foe’, a close HLA match is likely to generate the ‘friend’ response.  Stand down you white blood cells. A 'foe' reaction is likely to generate a graft vs host reaction (GVHD), a form of possible rejection.  But more about that later.

In the ‘old days’ (80’s) a 4/6 or 6 / 6 match  was thought to be ok to go forward.  Later on the ‘gold standard’ moved to 8/8 to the current 10 / 10 match protocols.  While that’s the generally accepted match now, there’s also a 12 / 12 match indicating an even better match.  If we want to go all technical,

matching for the HLA-A, -B,- C,- DRB1 and -DQB1 loci is referred to as a 10/10 match, when HLA-DPB1 is included it becomes a 12/12 match. Matching for HLA-A, -B, -C, and -DRB1 loci is an 8/8 match.

Short story is that given Kristina’s markers, there’s a sizeable pool of 12 / 12 matches, when really only 10/10 is needed

This is pretty dense reading, but a pretty good article from the national library of medicine outlining the matching process and different protocols followed by various countries. 

While this is good news, the focus of the G-Clam treatment is to get her blast cell count down – to 5% or under.  That needs to work and Kristina needs to be in sufficient health to accept the transplant.  Significant milestones remain to get to the transplant stage.