Transplant Day

 It’s transplant time

 Today is the day.  Kristina had her first total body irradiation (TBI) yesterday.   3 minute test, then 6 minutes on the front, 6 on the back.  She’s feeling a little fried after the session – like a day in the sun.

Today they’ll ‘pre med’ Kristina in preparation for the transplant.  Then the stem cells are thawed.  They’ll be a honey colored golden liquid in two bags and over the course of two hours they’ll be inducted via the hickman, and as stem cells are naturally programmed to get to the thicker bones, they’ll start to be absorbed into the ‘spongy bone’ and engraft themselves into the marrow and begin to populate new stem cells.  Hopefully they’ll multiply.  Kinda like rabbits.  If everything goes as planned, they’ll create different sorts of cells and get her bone marrow back to healthy blood generation.

We all know what ‘transplant’ means, but here’s a quick tutorial on how it works.  Yes, it’s way simplified, but your humble blogger is a simple guy. 

First the donor.  We’ve been through the matching process, but when Kristina says ‘the donor is being harvested’, gruesome pictures pop into my head.  It’s unsettling.  But when Kristina described the process, it’s pretty simple.  It’s not unlike giving blood.  There are some preparatory steps, but the actual ‘harvesting’ is pretty simple.  Take blood out of one arm, run it through a centrifuge to spinoff the stem cells and then put the left over blood back into the other arm.  Freeze it, and courier it to the patient.

If getting the stem cells out of the donor is relatively easy and fairly risk free, the process of getting them into the patient, Kristina in this case, is a bit more complicated.  With a wide range of side effects.

Chemo, and in Kristina’s case, radiation is involved to lower the immune’s system to battle the new stem cells.  The very treatment that allows the body accept the good stem cells greatly weakens the bodies ability to fight other infections.  Then there’s GVHD (Graft-versus-host-disease).  This is were the donor cells attack the patients body.  Even if the match is ‘perfect’, this can happen. 

GVHD comes in two forms – acute (within the first 3 months after the transplant) and chronic (after the first three months).  The acute form can cause rashes, diarrhea and jaundice and a whole bunch of other things.  Her care team will monitor and meds may be required to block the donors ‘T’ cells which are attacking Kristina’s cells.

The chronic form is more insidious and can be life altering owing to organ damage.  It’s nowhere near certain any of this will happen, but it’s a possibility.  Another thing to worry about.

Kristina is about to battle on several fronts.  Already weakened from the earlier round of Chemo as well as the ‘one two’ punch of the lumbar puncture and ‘maintenance’ round of chemo, she’s about to be further beaten down with the pre transplant chemo and radiation.  The risk of infection is going way, way up.  Even if everything is done correctly and all precautions taken, infection of some sort is likely.  Add to that the potential of GVHD which can wreak havoc.  So many unknowns, but she’s ready to push forward.

Two last requests – care giving is going to be a thing.  Kristina has asked her ‘tribe’ to sign up to be backups.  With a primary and a back up for each day, she’ll feel comfortable.  Take a look at September 17^th as well as there’s a coverage need.   That’s the non-financial ‘ask’.

Then there’s the financial ask.  Take a look at the go fund me page.   ‘Nuff said.

The next few weeks are the critical weeks. 

As a side note, her night time oncologist is a warm, intelligent engaging professional who affirmed the questions Kristina has asked have saved her life.  She affirmed that Kristina’s active engagement in her care have produced positive results, even going back to her two earlier bouts with this disease.