Unleash the Hounds! (D+120)

According to the protocol I'm following, patients start tapering their immunosuppresant drug 120 days after transplant. This drug has kept my new immune system from being fully functional, until now. A fully functional but grafted immune system, while useful for fending off bacteria, viruses, and fungi, could also mistake the host's liver or intestinal lining or skin as an enemy, leading to graft-vs-host disease. So far, luckily, I have had no GVHD symptoms.

I don't know what's different after 120 days. Maybe everyone has had enough time to get to know each other, or at least not go around picking unnecessary intercellular fights.

I am not quite following the protocol.

I had my D+100 biopsy on D+109. The initial results were as good as they could be. "Zillions and zillions of cells," to use my doctor's technical term. My next biopsy would be in several months (D+180). Having had the biopsy, I was able to start the transition from an injectable blood thinner to an oral one. (I have been on the injectable thinner since my pulmonary embolism, because it has a short half life and clears the system in a day. Blood thinners and bone marrow biopsies do not go together, and coumadin takes about a week to clear the system.)

On D+118, my doctor called with more bone marrow biopsy results, based on chromosomal analysis, and they are not as good as they can be. We would like to see none of my cells in the marrow, but 1% are mine, which we know because they have the XY chromosome. Worse, 2% of that 1% (0.02%) are leukemic. It's not enough to cause mischief, but it's the first evidence that we didn't get it all.

Fortunately, I now have a powerful weapon in this battle that I did not have in January: an immune system that should treat the native 1% as hostile threats. (Historically speaking, the 99% are the newcomers, but now they act like they own the place. This behavior should be familiar to students of U.S. history.) Starting two days ago, I am no longer taking the drug that kept my new immune system from attacking enemy cells. Over the next few weeks, the recently unleashed cells carrying the XX flag should be hunting down every blood cell foolish enough to wave the XY flag. While graft-vs-host disease is a problem, the related graft-vs-leukemia effect is beneficial.

Later this month, I'll have another biopsy to see how well the extermination campaign is going. Sadly, there is no special reward for filling my biopsy punch card. The last time, Jan bought me a pastry.