Transplant -4 (Sunday)

Today Jackie took her last chemo treatment. It went well with no problems.

I used my noxious concoction and sprayed the apartment for bugs, germs, creepy-crawleys, and whatever else might exist in the apartment. Who knows if it will do any good???

The chemo is beginning to have an effect on Jackie. She is now tired and nauseated most of the time. She has taken a lot of anti-nausea medications today, which in turn makes her sleepy. A good part of the day was spent in bed. For those who know her you know this isn't normal!

I wanted to send a special thanks to Ingjen Shih for the gift she sent. Jackie really like the folded origami cranes (and soaps too)! I also wanted to thank Nan for the angel food cake. I've haven't taken a bite. Jackie has almost eaten the whole thing.

Tomorrow is a "rest" day. We go in at 9:00 for a blood work appointment. They will draw blood for cultures and to determine the level of CSP (cyclosporine, the anti-rejection drug) in her bloodstream. Once a level is determined, her intake will be adjusted. The CSP is monitored and changed often. It controls the level of graft-versus-host disease (GVHD) that Jackie will experience. They could give her a high enough dose to probably prevent any GVHD but then she would not get any graft-versus-leukemia (GVL) effect. It is the GVL effect that kills off the errant leukemia cells that can be harbored in the remote regions of the body. So, the anti-rejection drugs play a vital role in determining how well this process happens. The problem is that GVHD can be very serious. Too little CSP and she gets very sick from GVHD. Too much and she will not get a remission of the leukemia.

On Tuesday Jackie will go through her radiation treatment. It will only last about 20 minutes. She is receiving a mini-transplant. The amount of radiation is the primary difference between a mini (or reduced intensity) transplant and a full-blown myloablative transplant. People getting the full transplant undergo almost a week of radiation treatments. Jackie will have only one treatment.

It will be a whole body radiation treatment. She sits in a special chair in a lead lined room with a door that is nearly one foot thick. The actual machine looks like something out of Star Trek! While radiation is very effective against killing leukemia cells I feel certain that in 100 years radiation will be viewed as our generation's version of blood letting.

Bruce and Jackie
from Rochester, MN