We have lived here in Cancer World for so long, I realize we do lots of bits and bits of how this works but I thought it might be time to sort it all out.
Mary-Elizabeth relapsed on September 28th of this year. The first step was to have her achieve remission or RE-INDUCTION. She was treated with two big doses of Blue Thunder. After thirty days she was tested again and they found .007 remaining disease but she was cleared to go through the first round of INTENSIFICATION.
Some kids go through 6 rounds of this combination of chemo, Mary-Elizabeth got off the regular protocol early and headed down Bone Marrow Transplant road.
She was always headed to transplant for a number of reasons. Her first encounter with leukemia was after age 11. It made her high risk so she was treated for 6 months longer. Because of the weird bump on the top of her head, she had 12 doses of Spinal/Cranial radiation. Said a different way, they gave her everything they could. Her leukemia lay dormant for 57 months and then came back with a vengeance. Transplant is her only option.
So here we are Day -1. It is the last day in negative world, we work toward only positive after tomorrow. Tomorrow is Day 0 and we count up from there. About noon tomorrow, they will start infusing two units of cells. They will look like blood. No big deal. No drama but I hear there will be a poster and a sign. Some families have parties and it is considered a new birthday. I am just going to sit and request that the universe re-align. I want to focus all the good forces to Mary-Elizabeth. Prayer, pleading, what ever we do, noon is the time. The bells need to ring, gunshots should be sounded. (James that means 11:00 your time.)
Ellie May and Pearl Ann are from the umbilical cord and placenta of two babies. They were donated by someone and have been stored in a bank somewhere. The cells are "manipulated". In other words they have been multiplied. The parts of the blood that cause reactions like platelets and other stuff is also gone. The cells were then stored, (frozen).
Mary-E will be infused tomorrow with Ellie May, Unit One and Pearl Ann, Unit Two. Each are matched on 4 of the 6 HLA factors. While this is not ideal, it has worked in the past.
http://en.wikipedia.org/wiki/Human_leukocyte_antigen.
She is not getting a "bone marrow transplant" in the sense that the new stem cells are not coming from someones bone marrow. Stem cells taken from bone marrow are from a working system. They are all grown up. They just move in and go to work. The cord stem cells are not grown up but they are more than willing to give it a good old college try. They float around the blood for about 12 hours and then migrate to the bone and start to learn their job and set up home. They are baby cells so it takes them a month to really figure out what they are doing, mature and swing into production. Then it takes awhile for them "to Show Their Work".
Then in time Ellie May or Pearl Ann will decide who will stay and who will be the cheer leader and leave after the game.
When the first ANC cells appear in the peripheral blood and they do some special dance and say some special words then the cord cells will have Engrafted and she will be headed back to her own life. We won't worry until it has been a month.
After ENGRAFTMENT, there will be the long road back to a real immune system. The new cells are baby cells and never will have seen a cold, RSV, the mumps, the measles, everything. by day 100 she will be half way there but the second half can be tough but is accomplished on a regular basis.
So the cells need to do three basic things.
1. Be working Bone Marrow
2. Learn to be happy with their new body
3. Build a new immune system so public places are not dangerous.
So, no questions are stupid questions, I ask them every day.
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