Marking Time Is Hard To Do

Did I tell you Harvey and I are both “Type A” personalities and patience is not in our list of skills mastered?

Day + 43 after the double cord blood transplant, we can say with greater confidence that the “Seattle Slim” baby boy cord is now more strongly entrenched. Last time we reported on the engraftment business, the breakdown was 50% for Seattle Slim, 30% for Carolina Lady 20% for good ol’ Harvey. Latest counts as of a week ago Seattle Slim is now in charge to the tune of 80%. Harvey and Carolina Lady are mere minority players at roughly 10% each.

I am also happy to report that Slim seems to have learnt the trick of making platelets. We are seeing gradual improvement in platelet counts, even though the last platelet infusion Harvey got was 13 days ago. As you may recall from an earlier post, platelet production is among the last skills learned by newly engrafted cord blood stem cells.

But I wish Slim was a little better at fighting infections, learning this skill a little sooner. Harvey is being treated for possible CMV reactivation (that is the only virus titer that went above the baseline, the only bug that tested “positive” thus far) with the standard therapy of gancyclovir. And indeed, the CMV titers are gradually falling in the blood, as one would expect.

But what we are not seeing is much of an improvement on the daily fevers. Every time the temperature spike is too high for comfort, they start him on yet another round of broad spectrum multiple antibiotics (Vancomycin, Ceftazidime this last time around) – so far this shotgun approach has produced few results. Harvey continues to get fever almost everyday – sometimes as high as 103. You can bet it scares me silly. The daily ordeal is also taking its toll on Harvey’s sense of well-being. It has been going on for weeks now!

The hardest thing to accept is that we are no closer to a definitive answer and therefore a game plan that we hope will take care of the problem once and for all. Once again, I am reminded that we are no where close to considering this or any other transplant protocol a slam dunk, a piece of cake for the patients and their families.

I have been pushing for a while that Harvey get IVIG (intravenous immunoglobulin) therapy, as another broad spectrum approach to controlling or eradicating whatever unknown bug (in addition to CMV) that may be ailing him. The experts finally agreed this is probably a sensible thing to do. Starting tomorrow, Harvey gets hefty dose of 500mg/kg of IVIG every week. Please wish him luck, we are hoping this new shot gun will kill anything that survived the intravenous antibiotic barrage.

Once again, I wish I had only positive and encouraging news to report. But in the absence of that, the best I can do is report the truth.

Be well,