Monday, October 6, 2008

"One more cup of coffee for the road" Bob Dylan

Sometimes the light's all shining on me
Other times I can barely see
Lately it occurs to me
What a long strange trip it's been

The Grateful Dead

This is strictly a medical post for the transplant crowd. Others are welcome to dip their spoons into the alphabet soup of engraftment seen in a reduced intensity stem cell transplant.

I face one more hurdle, before I can rest for a spell.  The HLA testing was redrawn today to see who is making my T cells. Hopefully this time my 14 tubes of blood will yield enough DNA to give the answer. The right answer, which is my donor. Go donor, go. The other blood lines are of much less import.

Here's the deal. After transplant, T cells hang around for a long time from that big bag dripped into my PICC line on July 1. That is why the long living T cell counts are higher than the other cell types earlier on because the transplanted monos and neutrophils die off pretty quickly.  The fact that my B cells are all donor 90 days out suggests these are mostly freshly minted B cells. My donor stem cells has taken up residence in the nooks and crannies of my marrow and are making at least some if not all of my blood now.  That's very good indeed. T cells DO NOT determine what the source of these B cells or neuts or monos will be. They just give the orders to them as to what is friend and what is foe. That is why they are so darn important. That is why T cell depleted transplants have more relapses in leukemia, but less GVH.

The T cell count does not always follow lock step with the other cells lines, but it's the boss so why should it. T cells originate in the bone marrow like all blood cells, but only become mature T cells in the thymus. 

If the T cells are 100% donor, then the chances of relapse are diminished. If they are steady, that  can be just fine too. If they are dropping, then that might or might not spell trouble. Here Dr. Forman and I do not agree.

Dr. Forman said my good news on my B cells was flirting. I think he mean it was tease. Let's hope the tease was just the preparation for the final act of consummation.

So one last hurtle. I am planning on going all the way, then I will rest.

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