BMT: Aplastic (Day +3)

One of the things we ask the doctors most often is… how do we know if Clark is doing well?  This isn’t like a cut, where you can see it scabbing and know it is healing.  Nor like a muscle, when you can measure its range of motion and strength.  So, what do we have to look at to measure progress in this phase?

As we talked about earlier, when destroying his existing bone marrow, we were most interested in Lymphocytes.  And sure enough, these were “crushed” to an immeasurable amount just as we entered transplant.  But what are we watching for now?

It turns out there are both positive and negative indicators that we will be focused on over the next 2-4 weeks.  The positive ones relate to growth of the new bone marrow, and the negative ones relate to attacks on his body externally and internally.

The positive measures will take some time.  This will come in the form of ANC, neutrophils and white blood counts rising.  We don’t expect to see any change in these numbers until about day +14. This is about how long it takes for the bone marrow cells to take root and start producing.

Until then, we are really just on the lookout for any negative reactions.  There are several measures that we are watching diligently.

One is fevers.  During the time Clark is Aplastic, he is really running without any immune system. So basically he is an open smorgasbord waiting to be devoured by viruses, bacteria, and fungus.  While we have several prophylactic drugs running through his body to prevent anything from attacking him, these are general drugs, as we cannot give him a drug to fight everything.  So we watch for fevers, and if he gets one, then we have to take a blood culture immediately and make sure it is a bacteria that we are addressing through the existing medication.  If not, we have to start giving additional medications.

The other more concerning negative indicator is (of all things) a rash.  A simple rash that grows worse over a couple days will be the number one thing we have to watch for.  Why?  This symptom is a strong indicator of graft-vs-host disease (GvHD).  If this occurs, we will have limited options available to us.  Most likely we will immediately start immunosuppressive therapy, to try and suppress the immune system and help the bone marrow “reset”.  This would be days of additional drug therapies, and it would be very stressful.

So, in a nutshell, we are trying to keep Clark healthy until the new bone marrow takes root, and at the same time hoping the new bone marrow doesn’t reject its host.  This two week phase is the toughest part of the treatment process, as it is simply a waiting game – void of many indications of success, but riddled with possible failures.