Two Towers

Day 19: Continued progress with the blood counts.  WBC back up to 0.6 and ANC up to 0.5.  We have also seen her platelet count go up and this is after the point where a transfusion would have had impact.  Over the past few days we have watched the platelets go from 17 to 18 to 28 today.  Platelets were always the cell line that dogged Annie so it is surprising to see them improving before hemoglobin.  But of course this is probably not Annie's old immune system we're witnessing.  Doctors won't officially say engraftment until she gets another bone marrow biopsy around Day 30, however unofficially she is displaying the signs of such an event.

An ANC of 0.5 is also a benchmark for being discharged.  There is talk that if she continues on this track she may be discharged at the end of the week to home isolation.  There are three milestones required for discharge.  One is being free of pain killers.  Two is being able to keep down some solids.  Three is an ANC of 0.5 or above for three or more days.  Annie has cleared one, was good on two except for the start of yesterday and today is the first day of an ANC of 0.5.

Since we're looking big picture, the two towers picture above is my go-to analogy for the entire transplant experience.  There was the first scary looking tower which represents all the nasty stuff in the beginning.  The surgery, the radiation, the chemo, the battery of meds and the infusion of cells.  Then there was the long flat run between the towers.  That is where we are now.  This run is scary for entirely different reasons and a myriad of them at that.  The fear of failing to engraft, risk of infection and endless possible complications.  Waiting at the end of this run is the second scary tower, GVHD.  Graph vs Host Disease is the gambit of complications that arise as the donor's system and Annie's system clash.  This is unique to every individual and donor.  Acute symptoms start as soon as the cells are introduced through engraftment and chronic symptoms begin to present around the three month mark.  These can require a life-time of management.  City of Hope is a world leader in the management of GVHD so we are in the best possible hands for facing the second tower.