BMT: Chemo (Day -2)

Clark “spiked a fever” last night.  He awoke at about 11pm with his legs and arms tucked beneath himself, and shivering slightly.  Patrick recognized it immediately, but in taking his temperature, it was not high enough to call it a “fever”.  An hour later, the nurse took Clark’s temperature again, and sure enough, we could then call it a fever.  Clark got some Tylenol to make him more comfortable, (so he could sleep) and some additional antibiotics. They also drew blood cultures from each broviac line to rule out a bacterial infection in the line.

This is Clark’s last day of Chemo, and it is worth celebrating a little. There is a long way to go, but this milestone is still an important one to note. Clark has been on a great trajectory, and the doctors have been very happy with his progress.  Clarks Lymphocytes are at zero, and other functions (liver, kidneys, etc…) are stable.

The final dose of Cytoxan will take 48 hours to clear the body after it is administered.  Fluids will be kept high during this time to ensure all of it is flushed through his bladder.

It is interesting to note that the effects of the Cytoxan have already taken place, but will not necessarily be visible outside of the body yet.  For instance, hair follicles have died but Clark’s hair may not be falling out.  Think of it like cutting the roots to a tree, but the tree will take some time to actually die.  These effects, if they are going to happen, will occur over a 2 week period from this point forward.

Part of the reason Clark has had very little symptoms is because he is getting about 5% of a full dose of Cytoxan.  This is very small, and therefore the side effects from this (short and long term) are expected to be minimal.  DKC patients are sensitive to these drugs, and so that’s why they dial them back.

So, you might ask, why not dial them back for all patients?  Well… that runs the risk of getting Graft-vs-Host disease.  This is definitely the biggest fear (of the many fears) that doctors have.  We need to balance not getting GvHD and giving too much Cytoxan.  Carefully walking this line will give us a successful transplant.  This line is where the art and science of BMT meet.