Rough Transplant Timeline

This is the rough timeline for Elise's stem cell transplant. The dates could easily change along the way.

3-4 Feb '14: pre-apheresis checkup and tests

16-20 Feb '14: pre-apheresis injections of granulocyte colony-stimulating factor (G-CSF) (aka Filgrastim)

18-20 Feb '14: apheresis - the process is described here

week of 11 May'14: travel to Bethesda, MD and set up apartment

week of 18 May '14: Hospital admission and tests

week of 25 May '14: Pre-transplant "Conditioning" begins

"Conditioning" includes chemotherapy and possibly radiation therapy. Chemotherapy and radiation destroy the blood-forming cells in the bone marrow to make room for your new cells. They also destroy the immune system so it can’t attack the donated cells after transplant.

The effects of the conditioning can range from mild to severe. Common symptoms resulting from chemotherapy and radiation include nausea, vomiting, diarrhea, hair loss, fatigue, loss of appetite and mouth sores. Some people develop all of these conditions whereas others develop only a few of them.

around 6 June ' 14: Transplant day ("Day 0")

7 June - 7 July '14: Pre-engraftment period (Day 0 - Day 30)

Engraftment is when the newly infused cells begin to reproduce within your body. Often the first sign of engraftment is a rising white blood cell count. For a peripheral stem cell transplant (most likely), engraftment will usually occur within 10-15 days post-transplant.

This is a very risky period as Elise will essentially have no immune system function making her prone to bacterial and viral infections. Additionally, as Elise's white count rises, she may experience graft versus host disease (GVHD). Graft versus host disease occurs when the white cells produced by the donor’s transplanted cells do not recognize the new organs and tissues as “self”. This happens because there are some genetic differences between the donor and recipient. Because of these differences, the new immune system may identify the host cells as foreign and will attack them.

8 July - mid Sept '14: Post-engraftment period (Day 31 - Day 100)

During this period, Elise will check out of the hospital and we'll all stay at an apartment in Bethesda, MD near to NIH so that we can make frequent, possibly daily, trips to NIH.. Her immune system will be gradually building. If she has GVHD it will be treated and any infections will be addressed immediately. She may need periodic transfusions. It's possible she could be readmitted to the hospital during this period. Elise will also have a tutor for school work during this period.

late Sept '14: travel home to Ridgecrest, CA (Day 100+) & follow-up care

The follow-up care could go on for a year or more depending on how Elise's system responds. Hopefully she'll be able to go back to school sometime during the fall semester, until then she'll have a teacher visit once per day to keep her on track with schoolwork.