T+203: Treatment to enter a new phase

My treatment is to enter a new phase that I will explain below.

Firstly, my blood counts are good. Haemoglobin 12.2 (a bit low compared to how I used to be, but very good), platelets 189 (normal), neutrophils 2.95 (normal) and lymphocytes an impressive 0.66 (normal is 1.5). This is the second or third successive rise in my lymphocytes, and shows a clear upward trend. The lymphocytes themselves are composed of B cells and T cells, and the T cells further divided into CD4 and CD8. The CD4 level is a critical indicator, and they will start monitoring it now that the overall lymphocyte level is rising; 0.2 is the level at which my drug regime will change. I am fit to travel:)

I got the results of the various tests that I have had recently:

• The FISH test was negative. This is a test for a relapse of cancer, and is less sensitive than the BCR-ABL test (which showed a very weak positive). This is good news, as it confirms that I probably have not relapsed. However, the BCR-ABL test does mean there are still some problem cells ...
• The lumber puncture they did in the new year showed no cancerous cell in my spinal fluid. Just two more of these to endure during this year!
• My second chimerism results show that I still have some residual host T cells and B cells, in fact very similar to the first test (taken in October). This is not unexpected, and it means that my donor lymphocytes have got used to them, and are unlikely to kill them, and this what we want so that I have 100% donor lymphocytes (my neutrophils are already 100% donor, but since my leukaemia is lymphocytic, it doesn't help). The next step is to harvest some mature lymphocytes from my brother, and inject them into me. These new donor lymphocytes are not used to me, and so will attack - hopefully killing my residual lymphocytes, but also causing GVHD. They treat me with these lymphocytes in increasing doses every 12 weeks, starting with a small dose and tripling it each time. The hope is that they will kill off my residual lymphocytes before causing me too much grief with GVHD.

This is how my treatment will evolve:

They are going to contact Harry (my donor brother) shortly, to arrange a screening medical. The lymphocytes are harvested in a similar manner to the original donation (via apheresis), but this time there is no need for any boosting injections, and the apheresis is shorter (about 2 hours). They take enough cells to dose me 4 times (a year's worth); the future doses are frozen. We will try and arrange the apheresis, and my first treatment for the week of the 6th of February, the week before I travel to the US. The timing is quite important, as I am likely to get GVHD from 4 to 8 weeks after the treatment, and they advise me not to travel in that period.

This time I will be able to visit Harry during his apheresis, Which I wanted to do for the original,transplant, but I became neutropenic and could not leave my hospital room.

I asked about travelling, precautions and so on. The doctor told me this (and I do trust his judgement):

• There is no point in wearing a mask on the plane. The masks offer some protection against bacteria, but nothing against viruses. You can get special anti-viral masks, but they are very uncomfortable and not warranted for me given my (good) blood counts.
• Whilst good hand hygiene is always a good idea, it mostly prevents the spread of bacteria. Since my neutrophils are normal, he thinks I don't need to take special care when travelling.
• I am no more likely to catch a cold on the plane than anyone else, but if I do it will just take longer for me to recover, and there is no special action I need to take; normal cold remedies are fine to use.

As to my well being, I am quite well. My ongoing phlegm problem seems to be almost resolved, which is probably due to the rise in my lymphocytes.

All in all, a very positive visit to the hospital!