Overtime

Day 123 (D - 15)

Sorry we have been out of touch with everyone for the past few days, but MDA has cranked the dial to 11. Just about every day has started before 6 in the morning and ended after 7 at night.

Before I get on to the details of test results and appointments, I do have something pretty cool to share with everyone. Ann's eyebrows are growing back (as you can tell from the photographic evidence). She lost them about two weeks ago, but now they are starting to grow back with the texture of a newborn's hair. Even though facial hair has nothing to do with leukemia, I like to think it is a small improvement that marks the apogee of our time here.

Ok onto medical stuff. Today we had another appointment with Dr. Alousi and he told us that the total number of CD34+ cells harvested during apheresis was 3.8 Million. Thats short of the 5 Million target, but he said that was enough for them to work with. Ann's stem cells will now go through a gene threapy treatment. They will then be mixed with mouse antibodies that have been "trained" to attack cancer cells. The idea is that they will filter out any remaining cancer cells in the harvested cells and, those same cells will form a "life boat" if the cells from the umbilical cords don't engraft correctly.

We had some pretty good news too. The pathology results for Ann's last bone marrow biopsy came back. The number of blast cells in her marrow were 1% out of 400 cells sampled, the normal range is between 1 and 5%. The 1% number is good, because it means that she is still in remission. What is better is that the pathologist didn't detect any traces of leukemia in the sample, or to put it another way the sample showed "no evidence of residual disease".

So this puts Ann in a pretty good position going into the transplant. I t does not speak to how easy her leukemia will be to eradicate with the mobilization chemo. Or necessarily how much trouble her new bone marrow will have in locating and killing off any thing that survives mobilization. Although the thinking is that the less evidence of leukemia there is prior to transplant and if there is some GVHD then there is less of a chance that the cancer will be able survive post transplant.

Ann also had to see the Ophthalmologist Dr. Kim today. Interesting side note: Dr. Kim attended high school in the magnet program at Baton Rouge High. It's a small world. Anyway, Dr. Kim checks all the allogeneic transplant patients over prior to transplant. Mostly to evaluate them before any optical GVHD occurs so it is clear exactly how bad it is and how it should be treated. Dr. Kim's conclusion after looking Ann's baby browns over is that her tear production is below normal and she should watch out for side effects like what she had with Cytarabine, but they are otherwise looking good.

We also passed the last sign post on the road to the CBT today. Ann got her apheresis double lumen CVC swapped out with a new triple lumen CVC. The triple lumen CVC is used for transplant patients here at MDA so that blood products, cells and medicine can be administered all at the same time. The good news is that is didn't hurt and Ann sailed through the procedure. The bad news is that this CVC is as large as or larger than the double lumen. At least she only has to have it for the next 4 months.