We are starting BMT Day 44 with an absolute neutrophil count (ANC) of 355! Woot woot! A couple weeks ago I mentioned the rare and serious complication called graft failure which is when the donor stem cells do not go into the bone marrow and multiply like they should by Day 42. Ashtyn has not technically engrafted with an ANC of 500 yet but stem cells are multiplying which indicates that her graft did not fail. What a relief!
When leukemia was in Ashtyn’s body on January 30th 2013, October 9th 2016, and February 14th 2018, the goal and hope was to get a BMT that would keep her in remission for life. I think of the process in four stages. Stage One: Receive one month of combination chemotherapy and repeat each month with different chemotherapy regimens until 0.00% leukemia is detected in a bone marrow aspirate and biopsy. Stage Two: Prepare for a BMT with a full two weeks of tests and workups to qualify, be admitted into the hospital for one week of conditioning chemotherapy and radiation, followed by receiving the donor cell transplant transfusion. Stage Three: starts on BMT Day 1 when the body no longer has an immune system. While waiting for the transplant to start producing white blood cells, countless medical interventions and critical care is used to manage side effects from the conditioning chemotherapy and the natural consequences of not having an immune system. Stage Four: White blood cells start multiplying. Healing and recovery begins. This stage lasts for at least one year as the immune system develops and the body recovers. Initially this stage includes slowly coming off IV nutrition as the gut starts tolerating food. Gradually less medications are needed as the body becomes more independent. With decreased medications and the ability to eat and drink, her central line will eventually be taken out. Physical and occupational therapy are used to build back strength, conditioning, and endurance. An anti rejection/ immunosuppressant drug called sirolimus is currently crucial and in months to come will be weaned off. Since recovery lasts over a year, it entails a lot. I’ll write about the process as we go along but for now, I want to give gratitude to all of you for helping us get to stage four.
Physical Therapy
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