“It does not do to leave a live dragon out of your calculations, if you live near him.”
― J.R.R. Tolkien, The Hobbit
It was bound to happen. Too many things were falling into place. We have an apartment lined up, utilities are scheduled, I sold my car in 1 day, Elise has finished nearly everything at school, ...
NIH called today and said there was an unexpected complication with Elise's donor. As I understand it the donor authorized peripheral blood stem cell collection but not a more invasive bone marrow harvest procedure. The peripheral blood stem cell collection method is preferred, but about 0.8% of the time the cells don't properly mobilize and so a bone marrow harvest is required. This is what happened to Elise when we attempted apheresis back in February and then again in April: her cells didn't mobilize sufficiently. So 0.8% seems like a remote possibility, but Elise's experience has been all about remote possibilities coming to pass. If only she could parlay this luck into winning lottery numbers!
The problem is that they'd planned for the stem cell collection on 4-5 June to support a 6 June transplant. That means they wouldn't know until after all the chemotherapy and radiation is already complete that the apheresis had been successful. And since the donor has chosen to not authorize a more invasive procedure if necessary, that leaves a 0.8% chance that Elise would have no immune system and no donor cells to transplant. Not good.
(I can't say that I blame the donor for their decision. Becky went through the bone marrow harvest process many years ago and it's no fun and takes some time to recover.)
So the fallback plan is to do the collection before chemotherapy starts and preserve the cells until the transplant date. NIH said they'd actually prefer this approach as the normal process, but for some reason the national bone marrow registry (?) only allows for "fresh" cells unless there is some reason (like this) to collect and then preserve the cells.
What this means is that the start of the conditioning regimen is likely to be delayed some amount of time; possibly as much as two weeks. We'll find out more tomorrow.
So we still have medical screening tests starting 0800 on Monday running through next week, but there might be a break in the action before conditioning begins. I guess we can use that time to get the apartment set up, go sight seeing, etc.
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