Post Stem Cell Transplant: Day +11

Diagnosis: Tami has Graft vs. Host Disease

Due to the high risk of infection and her physical discomfort, Tami is not able to have visitors at this time. 

Those of you who know me know that I am always pretty direct when it comes to, well, everything. So that is how I will explain what is going on with Tami's diagnosis of Graft vs. Host Disease.

Yesterday her doctors received back biopsy results that showed she does in fact have GVHD. The T-cells that were present in her new donor cells are currently attacking her small intestines because they don't realize they are now in another body. They think Tami's cells are intruders that must be destroyed, so that is what they are trying to do. There's no other way to describe this other then as bad news. How bad remains to be seen. GVHD can be mild (a minor setback) to severe (life threatening).  

Most often immunosuppressants and high-doses of steroids are used to slow the donor T-cells from attacking the patients own cells and body. The goal is to suppress the donor cells immune system without damaging the new marrow.

I've been mentioning day by day that it would not be unexpected that Tami might develop GVHD as I've read that up to 80% of transplant patients do develop it to some degree.

What is shocking is that Tami has developed the condition roughly a week after her transplant. This almost never happens. The typical timeline is 100 days with the earliest cases presenting at 20-30 days. Either way engraftment has already begun when most patients experience the onset of GVHD. 

Like me you are probably wondering if the early onset of GVHD is going to in any way effect Tami's new donor cells ability to engraft and begin forming healthy new blood cells and platelets in her body. I don't know but am going to do my best to find out.

Tami has skipped all of the most typical symptoms of GVHD like vomiting, diarrhea and skin rashes. Instead she has gone straight to a problem with a major organ. Thankfully her doctors already started her treatment last night at 5:00 pm. With just one treatment of Prednisone Tami noticed immediate improvement with the reduction of pain in her stomach area. 

Good News
All of the other tests that have come back so far have been negative for infections. This is great news.

While I would love to jump on a plane today and head up to Seattle to see Tami in person and give her moral support I know the best thing for her is to keep away until she is on the mend. Right now the Prednisone and Immunosuppressants leave her extremely vulnerable to infection by bacteria, fungus and virus'. What is normally an ordinary infection that would take a healthy person days to recover from can become a battle of life and death for anyone with Leukemia or Myelodysplasia who is neutropenic due to low white blood cell counts, especially for someone who has undergone Chemo and particularly for those under treatment for acute GVHD :( Since Tami is 3 out of 3 of those descriptions I don't dare risk exposing her to any random germs until she is going to be healthy enough to deal with them.

TPN

Also Tami has begun receiving nutrients through her Hickman Catheter. Total Parenteral Nutrition (also known as TPN) supplies all daily nutritional requirements. It is a solution that will relieve Tami of needing to eat while her mouth and throat are sore from the mucositis.

I hope later today I have some good news to share with you in an update.

Update 7:10 pm: Tami's stomach is still sensitive but yesterday's full dose of Prednisone helped enough that today she only received a half dose.

Tami did need a platelet transfusion today.

Hopefully tomorrow will be a better day for her.