Now for the tricky bit. The donor cells are in there, and they should find their way into the bone marrow where they will mature into the various blood lines: red cells, white cells and platelets. Keeping it to the simple metaphor of planting a new lawn, the conditioning has taken out all of the weeds and the old grass, removed rocks, and prepared the soil for the seeds. Now the seeds are in, the aim is to protect them while they root. So we need to keep the birds from eating the new shoots, keep the soil watered, and avoid new weeds, while making sure the kids don’t trample over the new lawn. Simple!
So now I am at my most vulnerable to infection. I have no effective immune system, and so I am being given various drugs to avoid infection: antibiotics, antivirals and antifungals. Even the smallest infection could be a big problem. Hence my room is kept incredibly clean, and all the staff are wearing PPE when they come near me. At the same time, I am having anti-rejection drugs to stop the donor cells being eaten by any of my remaining immune cells while they engraft.
Now we wait two or three weeks for the green shoots, when neutrophils should start to show up – the white cells that are the first line of defence.
How they worked all this out, beggars belief. As well as some good science, there must have been years of trial and error to get the protocol right.
Day +1
I slept quite well, but not long. Infusions started at 5, and as I usually get up about 6 it was hard then to get back to sleep. I was quite chipper this morning, but after my daughter left I slept solidly for nearly three hours.
The consultant this morning was very encouraging. The blip I had on day -2 was the chemo actually working and the temperature spike was not caused by an infection. The donor cells were plentiful and fresh, and so have a better chance of taking. When my neutrophils stabilise above 1 and if there are no other concerns then I can go home and just come to the day clinic.
The staff continue to be excellent and supportive. I’m getting to know them now and the conversations are two way. It is helpful to take an interest in others – it’s not all about me.
The poo concerns have flipped – I have a daily dialogue about my bowel movements. Now I do have diarrhoea. Hopefully it will clear up. I’m also retaining fluid, with some puffiness in feet, ankles, wrists and fingers, so they will give me some water tablets.
Overall, I am much chirpier today. Artemis is making its journey back to Earthly life.