Monday, March 23, 2015

Quite a process

The last few months I have given many people highlights of the process that Steven is going through and what the transplant, and subsequent treatments, consist of.  Obviously, my understanding of everything is limited, but is enough information to get the idea of what is taking place.  I thought, that maybe, I would try to explain that here.

When Steven was diagnosed with leukemia it was the appearance of excess blasts, or immature cells, in his blood that clued the doctors in.  The presence of the cancer was keeping the cells from maturing and doing their job.  In fact, a few weeks prior to finding out the news, Steven actually went to the doctor because a burn on his hand had become severely infected, and resulted in inflammation and swelling to the point that he couldn't bend his fingers.  The doctor prescribed an antibiotic and the burn healed and we were none the wiser. 

Looking back, it was obvious that the healthy cells were being taken over at this time by the cancer, and the new, immature cells were unable to adequately fight the infection that was brewing in his burn.

Steven had also been blaming a cold for causing him to feel short of breath.  However, when his stamina was significantly reduced, and he had to take breaks when carrying gates, he knew something was wrong. 

We now know that the red blood cells that carry oxygen to his organs were being compromised.

At the time, we had no idea what the real culprit was.

****

Leukemia is cancer in the blood.  That much most people know.  Bone marrow, which is located inside of your bones, is what produces the blood in your body.  (I didn't even know that much seven months ago.)

Stem cells, located in the marrow, are what produces the cells that make up our blood.


The chemo that Steven received in September was meant to rid Steven's marrow of the leukemia, and the defect that was producing the cancer.  However, because of the bad cytogenics, Steven's doctor knew that although he could get him into remission, the cancer would return.  It was for this reason that a stem cell transplant would be required in an attempt to save Steven's life.


In St. Louis we found that the first round of chemo did not get rid of the cancer.  Although the chemo initially cleared the marrow, when the marrow rebounded, it rebounded with the cancer intact.

At that time, a more aggressive round of chemo was prescribed, and thankfully, it stalled the cancer long enough for us to return on December 1st, to receive the chemo that would prepare his marrow for the stem cell transplant.  It was, obviously, more favorable to go into a transplant with no signs of disease (cancer) so that the new cells wouldn't have to immediately go to work.

The chemo in December wiped Steven's marrow clean in hopes that Jammie's stem cells would immediately take up residence and make themselves at home.

During the period surrounding the transplant, the doctor made it known that any cells counts that the doctors were reporting were not Steven's own.  The blood he had in his body was blood that came from somewhere else...specifically, a transfusion.  His red blood cell count was, at that point, comprised solely of transfused blood and he received several blood and platelet transfusions while inpatient. 

What I didn't understand until being in this situation is that the white blood cells are not part of those transfusions.  If I would have stopped to think about it, I guess it would have made sense.  White blood cells are our own personal immune system.  Putting someone else's in our body would be a recipe for disaster...at least, it would be in a normal situation.

*****

Two days after Steven finished chemo, his marrow was, essentially, "blank".  At this time he received the stem cells from Jammie.  The stem cells were fed through a catheter in his chest and, because they are really smart cells, they knew what their job was:  to find their way to the marrow and to start producing blood.

As I mentioned before, stem cells produce blood, and blood is comprised of white blood cells...which is our immune system. 

The risk at hand was that once the cells start doing their job, the white blood cells, which are being produced by Jammie's stem cells, would recognize that they were not in Jammie's body and begin doing their job, which is attacking all things foreign.  Steven, which is made up of foreign cells, would be one of those foreign "things".

The matching process finds a person that has a similar genetic make-up, in hopes of lessening the amount of "attacking" that goes on, which in technical terms is called GVHD (Graft Vs. Host Disease).

Steven was attacked by Jammie's cells on a low level, and, thankfully, has never reached anything near the life-threatening degree.  The rash we all prayed for was a low-level sign of the GVHD.  The reason that this was a good thing is that, although the rash was uncomfortable, it showed that Jammie's immune system was working...even though it wasn't in Jammie's body. 

And, Jammie's cells were still fighting even though they were being suppressed by drugs.  (This suppression is to keep Jammie's cells from seriously attacking Steven's body until it makes itself at home.  We want to keep the life threatening effects of GVHD at bay.)

The thought is that a new, working immune system should recognize the cancer as foreign, long after the new cells have made their peace with Steven's body and no longer view him as foreign.

*****

We have been told that the marrow has to be "babied" along for the first year.  It is temperamental.  It is new.  Steven's marrow had originally been occupied for 41 years by his own stem cells.  They might not like being thrown out and might eventually try to crash the new stem cells' party.

This is the reason for the many bone marrow biopsies that will take place this first year. 





During the bone marrow biopsy they insert a "needle" (I use that term loosely.  It looks much more substantial than any other needle I have ever seen.)  into Steven's hip bone.  Once they are able to penetrate the outer layer of the bone and make it into the marrow, they suction out (aspirate) the inner cells.  After getting the required amount, they then measure how much of the marrow is in the hollow of the needle and then pull out a portion of the bone itself.

These things are all sent out to be tested.  This test shows many things but there are three things that we wait anxiously for:

  • to find if there is any "disease" (cancer) present
  • to find whether or not the marrow is still totally engraphed with Jammie's cells
  • to see if the genetic marker (the one that drives the cancer) is present
This past Friday we found that there was no disease, the marrow WAS totally engrafted, and the genetic marker, still wasn't present.

We couldn't have asked for better news.  It has answered so many prayers.  However, we know that even though it is 100% engrafted now, Steven's cells could still try to take over.  (We don't want that.  Steven's cells apparently invite cancer to the party.)  We know that although the cancer is not there, it could decide to come back.  We know that the absence of the genetic marker is HUGE, however tomorrow is another day.

BUT, we also know that God has brought us this far, and by His mercy and your prayers, we have made it 100 days cancer free.

I pray that Steven can soon come off of his immune suppressants and that Jammie's cells aren't too upset about their new home.  I am ready to let them go full force against anything that would try to harm my husband.  They've already proved their tough by remaining totally engrafted, even while being pulled down by drugs, and I can only imagine what greatness those cells have in store when they are allowed to come fully armed into the fight.

Please continue praying for us all.




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