Day +2, Too Much of a Good Thing
Day +2, Monday, April 4th. Our two week spring break is over. Husband left the house at 4:30 a.m. to catch a flight to Ohio for work. Daughter was sunny and lively this morning despite still having coughing fits. She has one more day of antibiotics to address her bronchitis. Son stayed home from school and remained in bed due to his cold.
After dropping Daughter off at school at 7:30 a.m., I checked in with Mom and Dad. Mom was still in bed on the sleeper sofa. The lights were off in Dad’s room. Mom said that they had a rough night. Dad was now having diarrhea. After a minute or so on the phone with Mom, Dad needed to go to the bathroom. Alarms were sounding in his room. Dad was no longer allowed to get out of bed on his own. He was deemed too weak. I could hear the nurse, over Dad’s room’s speaker, telling my Dad to stay in bed until someone arrived to assist him. Needless to say, Mom and I ended our early morning call.
Dad FaceTimed me at 2:00 p.m. Dad was much improved. His eyes were bright and happy. He spoke with more vigor. The volume of stem cells and related fluids during the transplant infusion was rather large. Dad received 800mL on Saturday evening. Leslie, daytime nurse, said that transplant infusion volumes can be as small as a couple hundred mL to as large as 1 L (1000 mL). It is believed that the large volume of donor “fluids” received by Dad was the cause of his nausea and diarrhea. His body was unhappy about so much foreign substance.
I learned that Dad had a fever yesterday in addition to the nausea. It spiked at 101. This triggered the normal fever protocol to have a chest X-ray taken. Results from yesterday’s X-ray depict some spots. These spots have triggered a CT scan to be ordered. Dad should have the scan done today. Mom and Dad hope that Dad doesn’t require another bronchoalveolar lavage.
Dad mentioned that they rotated inservice BMT (blood & marrow transplant) doctors today. Dr. Khimani was now the inservice BMT.
Graft-versus-host-disease (GvHD) remains a major cause of morbidity and mortality after allogeneic transplantation, which is the type Dad received on Saturday. The older the recipient, the higher the risk for GvHD. We chatted with Leslie about Dad’s upcoming sirolimus medication on Day +5. Sirolimus prevents GvHD. Mom asked Leslie to print out hardcopy information containing facts, side effects, etc. about the drug. Mom studies all the drugs in detail.
Measures, previously developed that had significantly reduced GvHD, had been frequently associated with an increased risk of relapse. GvHD and graft-versus-tumor (GvT) effects are tightly linked, and balance between both reactions is difficult to achieve. The drug sirolimus has immunosuppresive, antitumor, and antiviral properties. Sirolimus’ unique properties give it an advantage over other immunosuppressive agents. It promotes GvT by allowing the new (donor’s) T cells to attack Dad’s remaining cancer cells, and it inhibits antigen presentation of by Dad’s antigen presenting cells (APCs). Recognition of Dad’s antigen by his new (donor’s) T cells commonly results in GvHD. Sirolimus also exerts antiviral actions, especially against the cytomegalovirus (CMV).
When FaceTiming with Dad at 5:00 p.m., Mom was making preparations to have Dad shower. Dad wanted to be showered for the evening before getting his CT scan at 6:30 p.m.
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