Day 23, Chemo Round 2 :: The Talk

Jade frequents the newly renovated Ronald
McDonald Family Room almost as much
as her beloved Art Room and Play Room!

We don't normally talk in percentages. Maybe because the numbers can be so scary, or because you can make numbers say whatever you want to. Maybe because we are already inundated by new vocabulary, treatment plans, diagnoses, side effects, medications, blood counts. I'm not sure if that's unique to this hospital, this unit, or what. But we don't talk percentages. (That has not stopped me from reading countless studies, books, etc.)

The doctors sat us down a few weeks ago for "the talk." The transplant talk. Heavy on information; light on statistics. We talked again about Jade's leukemia.  About how the fact that it has survived and resurfaced after five rounds of chemotherapy, after more than a year of being in remission means that the medicines that are currently available are not likely to make this leukemia go away forever.  That the medicines/chemotherapy that the oncology team is giving Jade are not strong enough to induce an enduring remission. That Jade's immune system is not strong enough to keep the leukemia in remission.

So, the BMT (Bone Marrow Transplant) Team laid out how we would go about replacing Jade's immune system after the doctors put her leukemia into remission with chemotherapy. It requires finding a suitable replacement, destroying the immune system that we gave her, and introducing a new system into her body.

Step One: Finding a Suitable Replacement
Identifying a donor for Jade consists of matching the Human Leukocyte Antigen (HLA) proteins that are on most of the cells in her body with those of someone else. It's not the same as blood typing. As a matter of fact, the blood type of the donor doesn't matter.  Bone marrow makes blood cells, so after the transplant, Jade would become the blood type of the donor.  8 HLA markers for Human Leukocyte Antigen are reviewed for bone marrow donations. 6 markers are reviewed for cord blood donations. The process for finding out if you are a match is very simple - only requires a swab of your cheek. You can find out more about how you can make a bone marrow or cord blood donation at www.bethematch.org.

Step Two: Destroying Current Immune System
Immediately before the transplant, Jade will be prepped to receive the donor cells with 8 - 10 days of high dose chemotherapy and potentially full body radiation. The chemotherapy and radiation that BMT administers is even more potent than what Jade has received to date.  Jade's system has been able to recover from the chemotherapy that she has received so far. Eventually, her body begins to make white blood cells, neutrophils, platelets, etc. again.  Jade's system, however, will not recover from the BMT chemotherapy. That is the intention... a clean slate ready to receive the donor cells and start anew.

Step Three: Transplant
Receiving the donor cells will look much like the blood transfusions that Jade has become accustomed to receiving.  A bag of the donor cells will be hung from an IV pole and enter Jade's body through her central line. 

Bone Marrow vs. Cord Blood

Still debating this low-tech visual aid for
a conversation of this magnitude... I guess
everything can't be a Prezi.

Jade's best chance for kicking this thing for good is to find a matching bone marrow adult donor, according to her doctors.  Adult marrow has been around the block, is used to fighting off disease, and would likely keep Jade safe from infections, etc. during the roughly 100 days post-transplant when she will be very vulnerable. It would also likely put up a winning fight against any solitary leukemia cells before they had a chance to replicate and take over Jade's marrow. Nip it in the bud, so to speak. The largest risk with adult marrow donations is the potential for graft vs. host disease, in which the donor cells recognize Jade's body as foreign and attack it - with symptoms that can range from a mild rash to organ damage.

If no matching adult marrow donor is identified, Jade will receive a cord blood transplant. Umbilical cord blood that has been donated by parents immediately after birth is frozen and stored in public cord blood banks. The advantage of a cord blood transplant is that these donations are more readily available and that the potential for graft vs. host disease is lesser.  These are "baby cells" that haven't grown up in a body yet and are less likely to see Jade's body as foreign.  The potential draw backs include that there are less cells available for the transplant, that they are baby cells that take a longer time to grow, and that they are not accustomed to fighting off disease or infection. 

There are tons of additional medications that Jade will be on pre- and post-transplant, many potential complications, numerous tests she has to take to make sure her body can handle all of this, but that's enough information for now.  Don't want to overwhelm you.

Thank you for checking in on Jade and for your continued prayers and support.  She is in great spirits, can't believe that there is another (two-year-old) Jade on the unit now, and looking forward to a break at home.

Today's Counts:
Hemoglobin: 8.5
Platelets: 27
ANC: 60