The last day of August: just back from the Glasgow clinic and time for a reality check.
In my rather simplistic thinking I had begun to believe that the biggest hurdles had been crossed; the minor dose of Graft vs Host Disease was behind me, my chimerism had reached 100% donor, and my haemoglobin had stopped dropping and was beginning to rise very slowly. It seemed that with 10 months since the bone marrow transplant I was well down the road to recovery, however this is a road of hidden potholes and the possibility of the occasional Taliban IED.
Having a ‘Reduced Intensity’ Transplant has meant that a very small amount of my own bone marrow has survived the onslaught of chemo but not enough to show up in the chimerism test; hence 100% donor. The latest test is now showing 89% donor, this will need to be monitored regularly. If the trend is for the donor cells to steadily lose ground, then they will need a boost of donor lymphocytes. My body is a battle ground.
1.
They do not want to give a lymphocyte transfusion yet because there is a strong risk it will spark off another dose of GvHD, of unknown intensity. However the chimerism balance may tip to the point where the possibility of the leukaemia returning may outweigh the GvHD risks.
2.
In addition my consultant reminded me that my immune system is still severely compromised: it is only 1/3 that of someone suffering from AIDS. Any major ailment could blow me away so I have to remain vigilant.
3.
The fight between the donor blood group A+ and my old B+ system means there are unusually large numbers of casualties on both sides that need replacing. This is putting further strain on the body which needs feeding with the right raw materials. Increasing the folic acid intake should help, (and not overdoing things in day to day activities, which is always tempting).
What a business ! And meanwhile the seasons march on: Autumn is in the air.
