We Have Engraftment!
A pause to celebrate!
Last Wednesday (Post-Transplant Day 14) the doctor told us it would likely be the worst day for the mucositis and things would change quite soon. He was right. Both about it being the worst day (to date anyway) and that things would change soon.
The marker for whether or not a transplant is working is the neutrophil count (those first responder white blood cells). The newly transplanted stem cells from Ben needed time to find their way to the center of Michael’s bones to begin making new cells in a process called engraftment. The days between his final radiation treatment and the beginning of engraftment are the most dangerous, because there is nothing left in Michael to fight off any bacteria, virus, or fungal infection. Michael’s red blood cells, white blood cells, platelets, and neutrophils were bottoming out, some at 0.06. This is the deadliest part of the process, we were told repeatedly, and the reason for the strict precautions like isolation, and gowns, gloves, and masks for everyone who enters the room.
Part of the plethora of information we read for potential bone marrow donors said you have the right to back out from donating at any point (bodily autonomy), but to keep in mind that if you wait to back out until the day of the transplant, after the high doses of chemo and six sessions of full body radiation have been given to the intended recipient, the intended recipient would likely die. Which of course gave us a low buzz of worry in the background… what would happen if the transplanted cells didn’t engraft?
Successful engraftment is when the neutrophil count is at or above 0.5 for three days in a row, and it usually happens on about Day 20. Tuesday Day 13, it was 0.17. On Wednesday Day 14, the worst day, his count was 0.5 but we were so overwhelmed with everything else going on it didn’t even register. Not until the next day, Thursday Day 15, when the results showed 1.67 did we begin to think things were turning around. Friday Day 16 and Saturday Day 17 his counts were 2.64 and 2.49, which means engraftment has definitely happened! Benjamin’s stem cells found their way to the right place and are in there making new blood cells, bringing Michael back from the cliff’s edge. Thank God!
We had very little time to celebrate, as the doctor informed us that though the deadliest part of the process has officially passed, we’re now entering a new phase which has dangers and pitfalls and plenty of jump scares to keep everyone carefully monitoring Michael around the clock: the onset of Graft vs Host Disease.
Graft vs Host Disease (GVHD) is when the new stem cells (the “Graft”) start doing their job, creating new, healthy cells which go on the hunt for invaders. Unfortunately, they sometimes recognize the recipient’s body (the “Host”) as something to be destroyed. This is common, expected, normal, and often only temporary, but sometimes massive debilitating damage ensues and it becomes permanent. This is the part where the team of doctors caring for Michael begins a complicated high wire balancing act, suppressing the cells just enough to not do damage while still allowing them to do what they are there to do, build up new bone marrow and a new immune system. Michael’s skin, lungs, liver, and digestive system are carefully monitored daily, as these are the four most frequent places GVHD loves to wreak havoc directly following successful engraftment.
I’m writing this pretty close to midnight on Wednesday, Post-Transplant Day 21, but it will go out tomorrow. The fact that Michael began showing signs of engraftment on Day 14 speaks to the general awesomeness of both Michael and our son Benjamin and represents the answer to bold prayers and fervent hopes from all over the globe.
Unfortunately we are already seeing moderate and increasing signs of GVHD in three areas which means Michael won’t be coming home quickly. More on GVHD and what it looks like for him soon. It’s been an exhausting week for so many reasons but I wanted to share the engraftment news because it’s a big deal… an encouraging step forward which deserves a post of its own without highlighting any of the other steps back.
Thank you for the messages of support and the prayers for Michael and our family. Michael is not replying to much at the moment but I’m reading every letter, card, email, and text message to him and they are all very deeply appreciated!
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