Houston, We Have Engraftment

Wow! Great counts this morning. White count was a whopping 2.7, up from 0.6 yesterday. Reds were up 10% and platelets up 50%. Can't ask for much more than that. I believe the stem cells have indeed engrafted.

Engraftment is where the stem cells find their way to the bone marrow and "make a home." Stem cells don't normally float around in the blood stream in any significant concentration. They belong in the marrow. In fact, the donor had to have a few days of Neupogen himself to stimulate the stem cells to leave the marrow and flow into his blood stream in order to be harvested. I got about 6 to 10 million of his stem cells I figure. The minimum needed is about 4 million. It's a little amazing that they come in one little freezer size plastic bag, heavy duty medical grade, or course. I have seen a few bags being delivered around here. They are literally in a little Igloo type cooler all taped up and tagged.

Dr. Shpall came in this morning and asked "How's my favorite engineer?" I told her great, especially with those counts. They took a quick look at me and said I was back to being their text book, boring patient. The young Virginia Tech pharmacist lady confided later that the fever was very "text book" and seems to be a precursor to cell engraftment, although they still have to treat it, to be safe, as though it's an infection.

They wanted me to have one more shot of Neupogen. I got it about an hour ago and haven't had any side affects yet. Go figure.

All in all this was a very good day. I got a good CBC (complete blood count), got a visit from Terry Irvin, my BMT bud from Pennsylvania, and made a few laps around the floor. I think Kenny, my brother, is going to visit this evening as he has almost every day. Leno is on tonight. Ahhh, the life.

Now that the cells have engrafted, they will be looking for GvHD, Graft versus Host Disease. With any transplant there are rejection issues. It this case, though, it's not a case of the body rejecting the new cells. It's that the new cells are growing someone else's immune system inside me, so I'm the foreign body, literally. Without the anti rejection drugs, the new immune system will try to kill various essential parts of me. The usual early symptoms include mouth lesions and/or rashes on the chest and back. It can be far worse, but that's what the Tacrolimus is for. Tacrolimus is the anti rejection drug they have been pumping in me since Day Minus 2.

The doctors actually want a little GvHD because it's evidence that the new system is indeed looking for foreign bodies to kill. Through the use of various drugs, the doctors limit those targeted foreign bodies to the leukemia and other disease. It seems my old immune system got a little chummy with the CLL, thought it was suppose to be there, and refused to kill it off. Hence, the need for a new immune system.

Terry Irvin said this morning that they had lowered his "Tac" level to induce a little GvHD and sure enough he had a rash on his chest, belly, and head. I'm not sure how long they will let those side affects run. GvHD is possible to get years after a transplant, so we will be on the lookout for rashes in the foreseeable future.

On the other end of the floor there is a "rogues gallery" of quite a number of BMT survivors. Their pictures are posted along with their year of transplant, occupations, hobbies, and best advice. One lady advised "Take life day by day. And if you can't do that, then take it moment by moment." Good advice for many of us, I suspect.

Ciao.