Thursday, October 8, 2009

So What Happened?

I'm aware that this post is a bit slow in coming but I think I've been trying to sort out the transplant day a bit.

We all arrived at the hospital at 8a as instructed by Clyde and her transplant team. She went in to the Infusion Center immediately for fluids. We were instructed to take turns visiting with her as the space is small and the schedule for the facility was very busy. Clyde's husband, Tom, was given a pass on the alternating but the rest of us, Rooch, Bee, Kay (our Mom) and Bill (our step-dad) and I went in and out while she got her fluids. The medical team also took a blood sample which is a routine done with such regularity that it's not even mentioned before it's done.

The "product" that had been collected from my blood the day before (Monday) was to have been seperated so some of it could be frozen for later use if necessary. The blood lab puts the cells through a process that accomodates for the fact that Clyde and I don't have the same blood type. They would also have bathed the cells to be frozen in plasma that was also seperated from my harvested blood. This keeps the blood's viscosity (slippery quality) for when it's needed.

In the meantime, the medical team was debating on whether they should split the harvested cells or give the entire bounty to her on this day. If I understand, the trade-offs at play here are effectiveness against the cancer versus the risk of Graft vs. Host Disease. The greater number of my cells given to her, the greater effect against the cancer but also the higher the risk of GvHD. Dr. Hamati, the transplant doctor, made the decision to give all the cells right away without freezing any. Given how closely our HLA (Human Leukocyte Antigens) matched, it seemed as though Dr. Hamati didn't consider GvHD to be as big a threat as it can be in some cases. With that, the lab's work on the "product" was reduced and the transplant proceded mush sooner.

Against the wishes of the clinic staff, we all crowded into the room where Clyde was set-up. Dr. Hamati took the little bag of blood product and hung it on the transfusion stand. Jan, the coordinator connected the bag to the lines permanently installed in Clyde's arm. When she opened the valve on the line, we all watched as the salmon colored fluid inched it's way towards Clyde's arm. I don't know how long that journey took but we were all completely focused on it. Finally, the "product" reached the needle in Clyde's arm and the process that cannot be un-done started.

The medical team stood with Clyde for ten to 15 minutes asking her questions about how she felt as the t-cells made their way into her system. Sometimes when a person gets the cells, there's a reaction the happens almost spontaneously. This is serious so the doctors were very careful to monitor Clyde's own perception of what was happening to her as the transfusion progressed. She reported no ill-effects. There were none. We all sat there joking, taking pictures and silently hoping that we were witnessing a miracle.

The whole "transplant", which was nothing more than a simple transfusion, took no more than an hour. It was almost anticlimactic. There was no "event". That was the god news. It was as uneventful as anyone could hope. The medical team was very pleased at how simple it went down. When the little bag was empty, Jan disconnected it and Clyde was free to leave. It was amazing.

Afterwords we did what all t-cell transplant patients do after the procedure, we went to the Laurel Tavern for a bowl of chili. It was unbelievable. Here was my sister, sick with lymphoma for 21 years, having had a t-cell transplant an hour ago, sitting in the Laurel eating chili. It was surreal.

Clyde went to the clinic on Wednesday for another round of Rituxin. Her blood counts were as expected-white counts very low and heading lower, red count and platelets holding their own. She feels tired but otherwise fine. She will avoid public places while her white cell counts recover but hopes to get outside. Her appointment schedule with the clinic is pretty full.

She started anti-rejection treatment on Sunday to ward off GvHD. The doctors monitor that very closely. It's important that some GvHD happens. That indicates that my cells are working against the lymphoma. The GvHD needs to be held in check however, so it doesn't attack and harm any vital organs. It's a very delicate balance. Clyde will be weaned off the immuno-suppression drugs in about a year if things go well.

The transplant itself didn't really solve any issues. What it did was put Clyde's recovery into nature's hands. We are again left to wait while the biology and chemistry of a t-cell transplant play out. We know that Clyde feels good right now. We know that t-cell transplants lead to complete remission about 60% of the time. We know that the path to recovery is not a straight line.

I'll keep you posted on Clyde's ups and downs on her road to recovery. Check back often. This story is far from over.

Be well.

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