Good news, we got a resolution on the question about the Rabbit-ATG.
Dr. Andersson came in just a few minutes ago and let us know that the ATG should not have been included in the treatment plan from the beginning. Why it was on the paper work that we signed is a question that has not been settled yet. However, it looks like Dr. Kebriaei caught the error sometime between us signing the papers and entering the hospital.
It’s a good thing too because if the ATG had been hung it would have basically wrecked the concept behind this transplant. This transplant is all about creating more GVH and GVL than would normally develop. ATG has two modes of action, the first is myleo-ablative (killing off marrow cells) and the second is to wipe out mature T-cells which control immune responses.
So ATG given in a normal transplant setting reduces the ability for the original immune system to "fight" back against the donor cells after they are infused. But ATG has a half-life that’s longer than a couple of days so after it is infused it acts on not only the original immune system, but the incoming bone marrow too. Which is bad if you want the marrow to come in fighting like they do in Ann's case.
Dr. Andersson was very reassuring and did an exceptional job of explaining what is going on. In addition Dr. Kebriaei is going to stop by later today and make sure every things copacetic. We're feeling better about everything already.