10-6-10 Thursday

Status: 9.25/10.  Feeling stronger each day.

 Events:  Went to Hopkins for a last checkup with our physician assistant.  She likened what’s in store to returning to a war.  “You’ve been on the battlefield before, and you know what to expect.”  Enjoyed immensely a visit this evening from dear friends Drs. Bill Schaffner and Bruce Gellin.

Comments:  I imagine when most people think about a transplant what comes to mind is a kidney transplant or a heart transplant, although nowadays they do livers, and lungs, and even faces.  The main worry in those transplants is rejection.  The body’s immune system sees the tissue as foreign and wants to destroy it.  Patients take anti-rejection drugs to lessen this normal biologic response.

 In a bone marrow transplant, they’re destroying the immune system and giving the patient someone else’s immune system.  So the donor’s marrow graft attacks the person who’s received it.   And those immune cells will then see me as the tissue to destroy.  It’s called acute graft vs. host disease (GVHD), and it’s the other significant complication with transplants.  Usually it’s first seen in the skin and mucous membranes, but it can progress to other organs.  To lessen its occurrence, I’ll be given some Cytoxan (another chemotherapeutic agent) after transplant that will tamp down an overzealous response.

 Paradoxically, a little GVHD is a good thing.  Not only does the new immune system attack normal cells, but it also attacks any leukemic cells left around.  In fact, the graft vs. leukemia effect is one of the major reasons for doing a transplant.  At a cellular level, a seek-and-destroy mission takes place, finding leukemic cells regardless of what crevice they’re hiding in.  So you want a little GVHD, but not a lot – a delicate balancing act indeed. 

 In most people, after a little while, your body and your new immune system learn to get along (I have no idea how this happens), but some patients have a continuing chronic graft vs. host disease.  It’s more common in patients who receive cells from a donor whose stem cells were harvested from the peripheral blood.  That’s why Hopkins preferred a donor willing to undergo bone marrow harvesting.

 A lot of risks involved, but as our PA said this morning, “High risk, high reward.”

 So I’m going to enjoy these next few days of the normal world.  I hope you have a good holiday weekend.  We’ll talk again on Monday.




3 Responses to “”

  1. wendy Says:

    I’m thinking this is somewhat similar in how astronauts might have felt venturing into the wild unknown of space. High risk, high reward. And you did get that first degree in astro aeronautics- just sayin’ and you did want to be the first physician in space, just sayin’
    Know you’ll do just fine and have great blog stories to tell us all about it.
    Here’s to the right balance!! Something we all want in our lives and now YOURS! Love and Prayers always, wendy

  2. joel steinberg Says:

    As we said yesterday: “No Nuthin'”. We are thinking about you and rooting for you every day. Joel and Margaret S.

  3. Tom Linden Says:

    Thanks, Bruce, for the lessons in what’s involved with a bone marrow transplant. I’ll be thinking of you next week when you check back into the hospital. All the best wishes, Tom.

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