Posted by Becky
Barring any more last-minute changes, Leif is scheduled to start the transplant process this Saturday, February 2, with three days of chemotherapy. It's as yet undetermined whether he'll get that chemo as an outpatient and spend a few more nights at home, or whether they'll go ahead and admit him to the hospital. Typically this is an outpatient thing, but with Leif's IV antibiotics and so forth, they may decide it makes more sense to admit him. We should find out tomorrow what the decision is.
Then they'll give him a day's break, and if he's not already in the hospital, they'll admit him Tuesday night. On Wednesday, February 6, he'll get a session of total-body radiation (approximately 2 grays) and then he will get a transfusion of donated peripheral blood stem cells from his anonymous, but clearly awesome (having rolled with a whole lot of last-minute schedule changes) donor.
After that comes a couple weeks of close monitoring and waiting for the cells to engraft, i.e. to set up shop in Leif's bone marrow. Because he's getting a "mini" transplant and not a myeloablative or "full" transplant, the chemotherapy and radiation is not designed to completely destroy his bone marrow. Instead, the principle is that the chemo and radiation suppress his bone marrow enough that the new, stronger cells take over his weakened immune system, and that they also recognize and destroy the remaining lymphoma cells in a process called the graft-vs-tumor effect.
The doctors decided to go the mini transplant route because of the recurring infections Leif has had. While currently improving and controlled by antibiotics, the infections are not completely cleared up. In a full transplant, the patient's immune activity goes to zero for weeks, and is subsequently suppressed to one degree or another for many months. While in a mini transplant there is still quite a bit of ongoing immune suppression, it's not as extreme at the beginning, which is better for someone in Leif's situation.
After the transplant there's a vast flowchart of things that may happen. The doctors will monitor Leif for infections, of course, and blood counts, giving him transfusions as necessary. They will also monitor him for Graft-vs-Host Disease (GVHD).
In a regular organ transplant, the patient's immune system recognizes the new organ (a liver, say) as "foreign" and will attack it. But in a bone marrow/stem cell transplant, the thing getting transplanted is the immune system. The new immune system can recognize the rest of the patient's body as "foreign" and can attack it in various ways; the skin, liver, gastrointestinal tract, and kidneys are organs that may be affected by GVHD. One can get either acute (right after transplant) and/or chronic (starting a while after transplant, and persisting for an indefinite period of time) GVHD.
The doctors want to see some acute GVHD, because it's associated with a stronger graft-vs-tumor effect--and that effect is the transplant's goal. However, they don't want to see too much GVHD, because in its extreme form it is life-threatening. They will juggle the amount of immune suppressant drugs they give Leif, with the goal of allowing enough activity by the new immune system to attack the cancer and protect him from infections, while not allowing it to run rampant and demolish his innards. It's a delicate balance.
We made a quick trip to Maine early this week to see a few friends and family - there's never enough time to see as many people as we would like, but it is wonderfully energizing for Leif to get back to Maine and see a few of the people he loves. I spent the time trying to catch up on my sleep and focus on work, which has been difficult lately since our days have been so eventful. The last few days Leif has been feeling pretty good. His pain (mostly in his bottom) continues to diminish. The IV antibiotic he's been taking makes him feel queasy and bad while it's infusing, but that goes away about half an hour after it's finished. His energy has been better, and his appetite has been enormous. He's been eating as much as he can, with an emphasis on healthy stuff, although really anything with calories has been fair game. After all, Leif's "junk food" is most people's "healthy snack." All hail PB&J and granola bars. He also continues to walk a good amount, and take lots of naps.
Barring any more last-minute changes, Leif is scheduled to start the transplant process this Saturday, February 2, with three days of chemotherapy. It's as yet undetermined whether he'll get that chemo as an outpatient and spend a few more nights at home, or whether they'll go ahead and admit him to the hospital. Typically this is an outpatient thing, but with Leif's IV antibiotics and so forth, they may decide it makes more sense to admit him. We should find out tomorrow what the decision is.
Then they'll give him a day's break, and if he's not already in the hospital, they'll admit him Tuesday night. On Wednesday, February 6, he'll get a session of total-body radiation (approximately 2 grays) and then he will get a transfusion of donated peripheral blood stem cells from his anonymous, but clearly awesome (having rolled with a whole lot of last-minute schedule changes) donor.
After that comes a couple weeks of close monitoring and waiting for the cells to engraft, i.e. to set up shop in Leif's bone marrow. Because he's getting a "mini" transplant and not a myeloablative or "full" transplant, the chemotherapy and radiation is not designed to completely destroy his bone marrow. Instead, the principle is that the chemo and radiation suppress his bone marrow enough that the new, stronger cells take over his weakened immune system, and that they also recognize and destroy the remaining lymphoma cells in a process called the graft-vs-tumor effect.
The doctors decided to go the mini transplant route because of the recurring infections Leif has had. While currently improving and controlled by antibiotics, the infections are not completely cleared up. In a full transplant, the patient's immune activity goes to zero for weeks, and is subsequently suppressed to one degree or another for many months. While in a mini transplant there is still quite a bit of ongoing immune suppression, it's not as extreme at the beginning, which is better for someone in Leif's situation.
After the transplant there's a vast flowchart of things that may happen. The doctors will monitor Leif for infections, of course, and blood counts, giving him transfusions as necessary. They will also monitor him for Graft-vs-Host Disease (GVHD).
In a regular organ transplant, the patient's immune system recognizes the new organ (a liver, say) as "foreign" and will attack it. But in a bone marrow/stem cell transplant, the thing getting transplanted is the immune system. The new immune system can recognize the rest of the patient's body as "foreign" and can attack it in various ways; the skin, liver, gastrointestinal tract, and kidneys are organs that may be affected by GVHD. One can get either acute (right after transplant) and/or chronic (starting a while after transplant, and persisting for an indefinite period of time) GVHD.
The doctors want to see some acute GVHD, because it's associated with a stronger graft-vs-tumor effect--and that effect is the transplant's goal. However, they don't want to see too much GVHD, because in its extreme form it is life-threatening. They will juggle the amount of immune suppressant drugs they give Leif, with the goal of allowing enough activity by the new immune system to attack the cancer and protect him from infections, while not allowing it to run rampant and demolish his innards. It's a delicate balance.
We made a quick trip to Maine early this week to see a few friends and family - there's never enough time to see as many people as we would like, but it is wonderfully energizing for Leif to get back to Maine and see a few of the people he loves. I spent the time trying to catch up on my sleep and focus on work, which has been difficult lately since our days have been so eventful. The last few days Leif has been feeling pretty good. His pain (mostly in his bottom) continues to diminish. The IV antibiotic he's been taking makes him feel queasy and bad while it's infusing, but that goes away about half an hour after it's finished. His energy has been better, and his appetite has been enormous. He's been eating as much as he can, with an emphasis on healthy stuff, although really anything with calories has been fair game. After all, Leif's "junk food" is most people's "healthy snack." All hail PB&J and granola bars. He also continues to walk a good amount, and take lots of naps.
Thanks so much for the detailed update. Good luck with this next phase of treatment!
ReplyDeleteThanks. With luck, it will be my last long stay in the hospital - something that I am quite looking forward to.
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