Over the weekend, Todd began making comments about his white counts not responding to the neupogen shots as they had in previous days. For the last month or so the trend has been for Todd to receive one neupogen shot every 2-3 days. This good sign demonstrated his body was making white blood cells and requiring less support. His recent lab results have shown that his WBC hasn’t been increasing as substantially after getting a neupogen shot. He’s needing a shot every other day. To us, this means Todd is needing more help than before and of course, thoughts of graft rejection entered our minds. Any time there is a pattern change there is cause for some amount of concern. For me, whether there is a sizable drop in Todd’s WBC, his red blood cells or his platelets, anxiety, fear and worry start to creep in.
The differences between transplant in fall of last year and now is that at the start of rejection in September/October which was around 30 days after the transplant, ALL of Todd’s counts were very low. His system was also not holding on to the neupogen, requiring that he be given shots daily to hold his WBC at around 2,000. Now, we’re at day +65, Todd’s hemoglobin/red blood cells and platelet counts have been holding steady which is good news, and he’s needing shots every other day or so.
Today, Dr. Carroll communicated not being overly concerned about rejection, though keenly aware of the possibility. He explained that Gancyclovir, medication to treat CMV – which came back negative in Todd’s system last week – have negative side effects on cell counts and these could be the possible culprit. The “60 day slump” can be expected in some patients and causes a drop in cell counts without the threat of rejection. If it is in fact the beginnings of rejection, we won’t know until we see obvious drops in all cell counts, and/or a bone marrow biopsy is performed. Either way, they can’t stop it from happening.
So, at this point in time we wait! We wait for Todd’s WBC to even out, hopefully into a better pattern than they are now. We wait for the second CMV test to be negative (results by Thursday), so he can have a few days off in between appointments. We wait for day +100 (the day after Easter), which is a very special day. All transplant patients strive to get to day +100 because it means they have a greater possibility of being cured of cancer. On this day, a bone marrow biopsy will be performed to obtain chimerism results again.
Of course, when I start to sense this fear come into my heart, I begin to wonder, “Is my hope in the outcome of this transplant?” or “Is my hope in Jesus, and all he has for me regardless of the outcome of this transplant?” It is such a struggle to trust Jesus day in and day out, especially when things are so uncertain. But, I’m thankful for the opportunity to wrestle with God, and learn more about trusting him in this process. I recognize I have no control and will choose to trust the One who does. For now, I will focus on His word:
“Cast all your cares on the Lord and he will sustain you…” Psalm 55:22
“Show me your ways, O Lord, teach me your paths; guide me in your truth and teach me, for you are God my Savior, and my hope is in you all day long.” Psalm 25:4-5
“Come to me, all who are weary and burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy and my burden is light.” Matthew 11:28-30
Filed under: BMT, CLL, post-transplant | 7 Comments »