Post # 45 Things are going well !!!!!

Day 2 through 4 went well for Bill. He continues to eat well and get his exercise. Day 4 was the first time Bill experienced a brief bout of nausea post transplant. Considering the high dose chemo he received, Bill is doing very well. Today is day 5 and I noticed an increase in fatigue.

Below is a table of his blood counts since T minus 3 days though this morning:

11/6 11/7 11/8 11/9 11/10 11/11 11/12 11/13 11/14
T-3 T-2 T-1 Day 0 Day 1 Day 2 Day 3 Day 4 Day 5

WBC 5.05, 4.54, 4.21, 3.80, 2.26, 1.04, 0.45, 0.20, 0.09
Hemoglobin 11.40, 11.30, 11.30, 10.90, 9.60, 9.80, 9.70, 9.60, 9.50
Platelet 97, 88, 102, 102, 102, 78, 73, 53, 39

An interesting note: A day after chemo ended we noticed an increase in all of Bill's levels which was opposite to what we had expected. According to the doctors this is expected since what is in the bone marrow is pushed out by the chemo and shows up in the blood stream, causing the levels to increase temporarily.

We are now entering the period of time when Bill is most at risk for infections. The only defense mechanism that he has is the drugs that he is receiving every day (see post #42 - 11/7/10).

WBC's fight off infections. As I mentioned, the drugs are acting as the WBC's since Bill has hit zero.
Hemoglobin (Hgb) in the blood transports Oxygen from the lungs to the rest of the body. When Bill's Hbg is less than 8 he will need a transfusion of 2 units of packed red blood cells (PRBC). Today his count is 9.50. Red blood cells have a life expectancy of approx. 3 months.
Platelets (Plt)- When platelets are too low, excessive bleeding can occur. When Bill's Plt's are less than 10 he will need a transfusion of 4 units of platelets. Platelets have a life expectancy of approx. 5 days.

During rounds today the doctor said Bill is in the best condition they could expect on day 5.

I was helping Bill get dressed yesterday and after he put on his shorts, I handed him a shirt and he gave it back to me. I asked what was wrong with the shirt and Bill replied it does not match the shorts. Even with the fatigue and weakness Bill insists his clothes must match.

Visitor corner: The following friends and family were in to visit with Bill this week:
Friends: Jadzia and Eddie, Jeff
Family: Margy, Lue and Kelli

Now on to technical information
New Drugs that I have not previously mentioned:

On Day Zero - November 9th, 2010 Bill started on Mycophenolate Mofetil (Cellcept) 1000mg IV every 12 hours. This drug is given twice a day for two hours to prevent Graft Versus Host Disease (GVHD).
From Wikipedia "Graft-versus-host disease (GVHD) is a common complication of allogeneic bone marrow transplantation in which functional immune cells in the transplanted marrow recognize the recipient as "foreign" and mount an immunologic attack".
After bone marrow transplantation, T cells present in the graft, either as contaminants or intentionally introduced into the host, attack the tissues of the transplant recipient after perceiving host tissues as antigenically foreign. The T cells produce an excess of cytokines, including TNF-α and interferon-gamma (IFNγ). A wide range of host antigens can initiate graft-versus-host-disease, among them the human leukocyte antigens (HLAs). However, graft-versus-host disease can occur even when HLA-identical siblings are the donors. HLA-identical siblings or HLA-identical unrelated donors often have genetically different proteins (called minor histocompatibility antigens) that can be presented by MHC molecules to the donor's T-cells, which see these antigens as foreign and so mount an immune response.
While donor T-cells are undesirable as effector cells of graft-versus-host-disease, they are valuable for engraftment by preventing the recipient's residual immune system from rejecting the bone marrow graft (host-versus-graft). Additionally, as bone marrow transplantation is frequently used to treat cancer, mainly leukemias, donor T-cells have proven to have a valuable graft-versus-tumor effect. A great deal of current research on allogeneic bone marrow transplantation involves attempts to separate the undesirable graft-vs-host-disease aspects of T-cell physiology from the desirable graft-versus-tumor effect.

Types
Clinically, graft-versus-host-disease is divided into acute and chronic forms.

The acute or fulminant form of the disease (aGVHD) is normally observed within the first 100 days post-transplant,[2] and is a major challenge to transplants owing to associated morbidity and mortality.[3]
The chronic form of graft-versus-host-disease (cGVHD) normally occurs after 100 days. The appearance of moderate to severe cases of (cGVHD) adversely influences long-term survival
Classically, acute graft-versus-host-disease is characterized by selective damage to the liver, skin and mucosa, and the gastrointestinal tract.

Twice since starting Tacrolimus Bill has required Magnesium sulfate in Fluid 50ml 2 gm IV. Tacrolimus is used as an anti rejection drug. Tacrolimus is known to waste magnesium in the body. The treatment of Magnesium Sulfate is to maintain the bodies levels and replenish what Tacrolimus has wasted.