Monday, May 26, 2014

Day -4 Three Types of Chemo (Treosulfan / Fludarabine / r-ATG) & Inspiration from a Nobel Prize Winner.

Upon entering the transplant floor at SCCA, proudly displayed on the wall is a modest picture of the late E. Donnall Thomas, who is known as “the father of the bone marrow transplant.” In 1957, in a paper published in the New England Journal of Medicine, Dr. Thomas theorized that leukemias, lymphomas and other blood disorders could be cured with an unorthodox, radical procedure: destroying a patient’s blood and immune system with lethally high doses of chemotherapy and radiation, and then rescuing them from the brink of death via a transplant of healthy bone marrow.

In the late 1950’s, Dr. Thomas performed the first successful human bone marrow transplant. This was during a time when rare bone marrow failure diseases, such as Aplastic Anemia, were almost always fatal within months of diagnosis.

Many prominent physicians continued to doubt Dr. Thomas’ theories about bone marrow transplantation well into the 1970’s. However, he was self-admittedly stubborn and never gave up. In 1990, Dr. Thomas won the Nobel Prize for his pioneering work in bone-marrow transplantation. To date, over 1 million bone marrow transplants have been performed. Thanks to Dr. Thomas’ persistence, and the selfless act of a complete stranger who has agreed to donate his bone marrow, Ryan will join that list of patients in 4 days.

“Imagine coming up with an idea, making it a reality and touching that many lives.” – Fred Appelbaum, Thomas’ friend and the Executive Vice President & Deputy Director of the Fred Hutchinson Cancer Research Center.

This morning, Ryan had fun again with Grandma Terry. They tested out the various ”vehicles” available on the SCCA unit here at Seattle Children’s. He had to settle on a pink girl’s bike because his legs were too long for the other rides he tried.

Later in the day, a new chemo was added to the mix: Anti-Thymocyte Globulin (r-ATG). It is made from rabbit antigens against human T cells, and is used to prevent Ryan’s body from rejecting the donor’s bone marrow (graft rejection). Ryan had a similar drug last July in an attempt to “reboot” his immune system to fight Aplastic Anemia, but it was made from horse antigens (h-ATG). Within 2 hours of starting the r-ATG, Ryan began puking. He has two more days of this particular chemo drug. However, “serum sickness” from this drug, along with bone and muscle pain (among other things) can last for weeks or longer, after receiving the drug.
We ended the evening with his nightly bath, followed by a required wipe down with warm cloths that contain chlorhexidine (a disinfecting ingredient also used in surgical scrub). This is necessary because, as Ryan’s bone marrow is destroyed, his ability to fight off germs, including those that live naturally on human bodies, will be nonexistent. The problem, is that he seems to have a skin sensitivity to the wipes and his back itched so bad last night that he was in tears. Tonight, I let the wipes cool while he was taking his bath and I asked him to try them again at the cooler temperature. He was scared and upset, but I was surprised when he let me go ahead and wipe him down. I told him I am really proud of how brave he is and he said “No, I’m not.” And I said, “Yes you are - there are a lot of grown ups that are not as brave as you! It is okay to cry or be upset when things hurt or scare you. What makes you brave is that you keep trying anyway.”

No comments:

Post a Comment