The Chimerism analysis shows that 99% of Mama Pham’s cells are the donor cells! This is great news. It means that engraftment is happening (her body is taking the donated stem cells) and that the body is not making bad cells. Day 57 and going strong!
I like the Seattle Cancer Care Alliance’s description of the chimerism analysis:
A Chimera was a creature in Greek mythology usually represented as a composite of a lion, goat, and serpent. Contemporary use of the term “chimerism” in hematopoietic cell transplant derives from this idea of a “mixed” entity, referring to someone who has received a transplant of genetically different tissue. A test for chimerism after a hematopoietic stem cell transplant involves identifying the genetic profiles of the recipient and of the donor and then evaluating the extent of mixture in the recipient’s blood, bone marrow, or other tissue.
The first 100 days post-transplant are the most critical days. Physiologically, is the time when the patient’s immune system is most suppressed and the patient is most week. Emotionally and mentally, this is when the patient is quite vulnerable, trying to slowly get life back together. The first 30 days are spent in the hospital where doctors check-in daily, nurses monitor 24/7 for irregularities, patients are fed through IV if they can’t eat, and someone is always there to make sure the right meds are taken. Once the patient is discharged, it is critical that the patient continues to take very careful care to make all the right medications, eat properly, maintain a clean home and constantly be on alert of irregularities in bodily functions. Fever is the most important sign to watch.
Taking the right medication at the right time is very critical to maintain the correct chemical balance to fight off infection, prevent off Graft vs. Host disease but allow the body enough strength to fight off any lingering Leukemia blasts. This is where we trust the team of doctors and pharmacists to know the right drugs to combine for the best possible outcome. So glad chemistry is in the medical curriculum! Below are a sample set of some of her current medications:
- Tacrolimis – immunosuppresent to help prevent Graft vs. Host disease, adjusted based on Complete Blood Count every few days
- Sirolimus – immunosuppresent to help prevent Graft vs. Host disease, adjusted based on Complete Blood Count every few days
- Acyclovir – antiviral
- Sulfamethoxazole – antibacterial
- Magnesium – Other medications cause a magnesium deficiency
- Zofran – nausea
- Protonix – acid reflux
- Ursodiol – potential gall stones, help with liver
- Baraclude – preventive measure for Hepatitis B because this is a common liver condition among Asians who have not been vaccinated. Since my mom’s immune system is suppressed, it is critical that we prevent Hep B
- Voriconazole – antifungal
With so many different, changing medications, we need to constantly check to make sure her chemical levels are good and that the drugs do not negatively interact. One example is that we want to keep the Tacrolimus and Sirolimus level at the perfect balance so that graft vs. host disease (GVHD) does not happen. However, the two drugs suppress the immune system, which means they inhibit the body’s ability to fight off evil things (like Leukemia blasts). We eventually need to lower this dosage or stop completely so the body can get stronger. There are risks when suppressing the immune system too much, but also risks when not suppressing it enough!
Day 100 is the milestone for most post-transplant patients. It is when they can cut back on the 2x/week doctor visits, possibly go off the neutropenic diet and overall start getting back to somewhat of a normal life. We are at day 50, which is half way there!
Mama Pham’s taste buds are still shot, she is still weak, the stent occasionally bothers her and she still has to make the 1 hour trek to City of Hope twice a week, BUT she is still cancer-free! We just need to manage the side effects until she gets strong again. The 100 day milestone is a great milestone. Then we will celebrate the 1 year milestone and then the 2 year milestone!
After spending most of our time just driving between home and the hospital, I decided it was time for some ocean therapy on a beautiful day. Completely covered from head to toe, sunblock on any exposed skin and sporting a mask, we went to Corona del Mar and took a little stroll down the empty tree-lined streets and along the cliff side.
The spinal tap came back clear. There are currently no cancer cells in Mama Pham’s Central Nervous System!
We have had numerous calls from the pharmacy telling us that some medication is not covered by insurance. They said that if the doctor can verify that the patient really needs the medication then the insurance will cover it. One call to the doctors’ office usually does the trick. My question then is this:
How often do doctors prescribe medications that patients do not actually need?
Today is Day 35 post transplant. My mom had a bone marrow biopsy done on Monday, Day 32 post transplant. The results CAME BACK CLEAR. For first time in a long time, Mama Pham’s blood and bone marrow are CANCER-FREE!
Dr. Salhotra performed a spinal tap and CNS prophylaxis (chemo into the spine) today. We will find out in a few days if any cancer cells infiltrated into the Central Nervous System. If there are cancer cells there, then the CNS prophylaxis must be done with aggression. If there are no cancer cells, then we can be done ever 4-6 weeks for prevention. Not fun, but not as bad as having to actually treat active Leukemia in the CNS!
For now, we fill revel in the glory that the bone marrow and blood are cancer free!