Day +11: Engraftment

There is so much news!  And each bit of it has such MAJOR implications.  I will try my best to help you all understand the "so what does this mean??" part of it.

• White Blood Cell Count = 0.7 (up from 0.4 yesterday)
• Remember white cells fight infection. And while we didn't have an ANC, it was the only number we had to gauge if she was producing new cells.  If her white cell count continued the trend up, it meant she is producing those all important blood products to sustain life and fight infections!!! This morning we heard from the nurse that she had 0.7, but hadn't seen her full lab report yet.  BUT, we knew that if she is above 0.5, then we have an ANC!
• ANC = 190 (up from nothing yesterday)
• Remember ANC is Absolute Neutrophil Count.  Neutrophils are one of the types of white blood cells that fight infection.  The ANC is a number that we watch a lot and when it reaches 500 for 2-3 days in a row, she can go off isolation restrictions!  This means we can go for walks around the hospital and outside, etc!!!  Technically it means we can go home, but there are other criteria and logistics she has to meet and that have to be coordinated first.)
• Monocytes are another type of white blood cell which we are seeing in the lab report today.  I don't know much about them, but the attending told us this morning that WE KNOW SHE HAS ENGRAFTED because she is producing monocytes!!!!!!!!!

So, this is where we all take a break from the education and scream, dance, laugh, cry, sweat (yes I was almost doing all of those simultaneously during the doctors' rounds this morning), whatever you need to do to get let the joy of the moment of Day 11 engraftment take over your normal, mature, appropriately inhibited self!!!

Ok. So. Guess what else?

We are past the point of worrying about veno-occlusive disease (VOD).  Remember we had been watching her liver enzymes really since transplant.  We don't have to worry about that any more although her liver can still be an indicator for other things.  But this is one BIG thing that we can officially say we have avoided and for which we are "out of the woods!"

So, now begin a new phase of looking for Graft vs. Host Disease (GVHD).  We actually expect to see GVHD, and we actually want a little bit of it.  The Graft is the donor's marrow and Clara is the Host.  Just in case there is one single leukemic cell left behind in Clara's marrow, we want the donor's new immune system to kill it.  Of course, we don't want his immune system (which will be created by his marrow) to decide it doesn't like Clara and gets strong enough to try to kill all of her cells and officially her.  So, we keep an eye out for symptoms and we keep it under control.  They've gotten very good at treating GVHD.

Ok. So.  The BIGGEST NEWS THAT YOU HAVE ALL BEEN WAITING TO HEAR!

If everything goes well...
If her ANC continues to climb...
If her Graft vs. Host Disease arrises, as long as it doesn't become severe...
If she can tolerate some food by mouth...
If she can take many of her meds by mouth...
If she isn't having fevers...

We could go home in 10 days!

Enough said.  REJOICE!