Monday, July 14, 2008

Bad to the Bone George Thorogood and also CLL Canada

Day 13+ (87 to go and then some)

This one is only medical, but I will try to avoid jargon. I will move slowly though my points, and you non-CLLers and non-BMT readers, might still find it interesting.

I am very very very immunosuppressed. Our G-d given immune system is most redundant and extraordinarily complicated. I will make no attempt to untangle that twisted web for you, but I will grab some of the low hanging fruits of knowledge and explain how it applies to me.

First, because my bone marrow has been suppressed, I am not making nearly enough neutrophils, the most common white blood cells that is the back bone of the immune system. Because of their short life span (they work a 12 hour shift in the blood and then die), they are a good marker for not only how my bone marrow is doing, but also when my new bone marrow is kicking in. In fact, when my neutrophils are over 500 three days in a row, that suggests my graft is starting to work. The great news is that my nascent neutrophils have climbed from 70 to 300 in only 4 days. Go graft go! There is nothing magic about the 500, but as the number (my ANC) climbs past that mark and especially past the 1000 barrier, I am at less risk of a bacterial infection such as a life threatening lung infection. 

My cancer is of a different white blood cell (WBC), the B lymphocyte. It is involved in humeral immunity. The term humeral is a holdover from Hippocrates and the 4 humors. Medicine can be slow to change its revered terminology. Humeral is differentiated from cellular immunity which is mediated by the T lymphocytes.  B cells are involved with making specific antibodies against specific invaders, a learnt response. A good example of  B cell directed learnt antibody production is the protection we get from vaccines. In contrast, T cells can organize and directly destroy the invaders themselves, mano a mano. The cell itself is attacking the bacteria or virus, hence its moniker, cellular immunity.

I have already almost no antibodies because of my CLL, and now it is worse because of the chemo: FCR. The Fludarabine (F) is famous for knocking out T cells to levels of those with AIDS. This is good in that it prevents me from rejecting the graft, but my risk of infection is long term. Cytoxan (C)  suppressed the growth of everything in the marrow. Rituxan(R) knocks outs by B cells, healthy and cancerous.  And I am also on tacrolimus and sirolimus, two mushroom extracts that suppress my T cells so first I don't reject my graft, and secondarily my graft doesn't reject me (graft versus host disease).

So you get the picture: A blasted bone marrow, dangerously few neutrophils (neutropenia), depleted and suppressed T and B cells, and almost no antibodies (immunoglobulins). The recovery with be erratic, with the neutrophils coming up first, but it may be some time before the rest of this system is humming. My antibodies may never fully recover. I remain at long term risk for opportunistic infections, like fungi, parasites, and common bacteria that live harmlessly on our skin. or in the soil. So I need to be vigilant, long after I am out of here and long after the first 100 days. A small price to pay for a cancer cure.

The infectious disease specialist saw me today and confirmed the diagnosis of Herpes Simplex (HSV or the common cold sore virus). 90% of us have had this virus which lies dormant in our nerves. Sadly, but truthfully, herpes is forever. For most of us that is not an issue as it is kept in check by our normal immune system. As I explained, mine is missing in action, hence the flare-up. The good news is with the increased anti-herpes meds I am feeling much better.

Even this vegan knows, that to make an omelet, you must crack some eggs. I have gotten cracken.


Blogger Unknown said...

Cool, you are starting to engraft. Go donor-marrow go. All of the other information is par for the BMT course so I think you are doing very, very well. Keep up the good work and make sure you eat!

July 15, 2008 at 2:07 PM  

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