Day +22 and GVHD

Still Missy here.   Today marks day +22 since the SCT.  Good news is those new cells are engrafting and setting up shop in Doug's body.   But, like everything else with this disease, it has not been an easy engraftment process.

Doug is still in the hospital.  He had a really rough day with vomiting on Saturday and then fevers on Sunday, so they put him on watch and wait mode here hoping they could send him home the early part of this past week.  Around that same time he also developed what seemed like a nasty cold.  He was feeling so sick with nausea and violent vomiting that he was eating nothing.  On Monday they did a CT scan of his head to see if the cold had settled in his sinuses and to ensure that with all of his forceful sickness, he had not  burst a blood vessel somewhere in his head.  The CT scan came out clear for that, but did show sinus inflammation.  They started him on IV antibiotics to treat the sinus infection.  By the end of the day Monday a lacy like rash popped up on his body.

While all of this was going on, his liver enzymes had also started to creep up. Each day they were basically doubling until by Thursday they were at 50x greater than the normal range.  On Wednesday, as the numbers were getting quite concerning, the doctors started him on Prednisone (a steroid) to help treat what they thought might be the beginning of graft vs. host disease (GVHD).  They also decided they wanted him to have a trans jugular liver biopsy on Thursday morning which could help them rule out certain things and confirm their course of treatment.  For the biopsy the doctors went in through his jugular vein and threaded their way down to his liver to help themselves to a small sample of it.

They were looking for one of four things in the biopsy, but of the four, the two most likely culprits would be Hepatitis or GVHD.  Doug came into the SCT negative for hepatitis, however we do know his donor did have it present at some point in his body.  Not currently, but at some point which made it possible that Doug could now have it.  I think in a previous post Doug talked about having to sign off on his European donor to acknowledge that Doug could get Mad Cow or Hepatitis from the transplant.  A small price to pay if it beat the leukemia.

At 5pm today we got confirmation that his liver is showing mild signs of GVHD.  The fact that it is mild is good.  However, they did find that he does have some acute liver cell damage that is more than they would typically see with a mild GVHD.  Currently they are not sure why he has this acute damage or what it is from.  It could be in response to a drug or combo of drugs he has had to take in treatment or it could be something viral.  The good news regardless, is that his liver function held stable today and did not climb more.  They are looking at that as a sign that the Prednisone is helping to treat the GVHD and we should expect to see the liver enzymes continue to go down.

All in all the doctors feel confident the rash from earlier in the week, the nausea and vomiting as well as the confirmation of the liver showing GVHD is just that - Graft vs. Host Disease.   To help with a base understanding of what it is, "GVHD is a common complication of allogenic SCT in which functional immune cells in the transplanted marrow recognize the recipient as "foreign" and mount an immunologic attack."  I have to credit Wikipedia with the explanation there.  Basically as engraftment has been occurring, the German is fighting Doug's body since those cells know it is not their normal environment.  It makes me wonder if they are attacking the liver hard as they recognize it is not an Octoberfest and bratwurst laden liver.  Although for those of you who know Doug well, you know he likes good beer, and he used to have a serious penchant for "cheddarwurst" - perhaps one of the most disgusting meat products available.  I think even the Germans would concur.

Right now Doug is sleeping.  He has been sleeping about 20 hours a day although not necessarily restfully.  He has still had nothing to eat since Saturday morning of last week and no IV nutrition due to how taxing it would be to his liver in its current state.  He is extremely weak right now from all he has been through this past week and his weight is down to 163 lbs.  As we all know, he is strong and will fight through all of this.  He has a goal once this is all over to get back into doing triathlons.  He is convinced his leaner frame will at least make the swim easier than his old huge muscular sinking thighs ever did!