“I pass with relief from the tossing sea of cause and theory to the firm ground of result and fact.” -
Winston Churchill
After 6 months of planning, hospital visits, middle of the night worry, and soul searching, Elise started the conditioning process for her stem cell transplant today with the first of five doses, one each day for the next five days, of a drug called Alemtuzumab.
Alemtuzumab, or "Campath" is monoclonal antibody that binds to a protein present on the surface of mature lymphocytes, but not on the stem cells that create these lymphocytes. After treatment with Campath, these antibody-bearing lymphocytes are targeted for destruction by the immune system. Or in layman's terms, this medicine causes your body to kill off its own T-cells which fight infection.
This is the first of three "big gun" conditioning therapies used before the transplant to prepare Elise's immune system to accept the donor's stem cells. The next two are Busulfan and then "total body irradiation", but I'll cover those two in a future post.
Campath is given slowly over a couple hours for each of five consecutive days. The side effects are said to be the worst on the first day and gradually becoming less severe each day after. The official website says: "Campath administration can result in serious, including fatal, infusion reactions. Carefully monitor patients during infusions and withhold Campath for Grade 3 or 4 infusion reactions."
They prepare for the worst. Before they started the drip of Campath, they premedicated her with a max dose of tylenol and benedryl. The tylenol prevents the fever, chills and body aches that are the predominant side effect of Campath. The benedryl reduces the chance of an allergic reaction and also helps to calm the recipient.
I was prepared for what I thought would be the middle of the road reaction: an allergic reaction that caused some breathing issues and a fever and body aches. What Elise had was nothing of the sort. The benedryl made her sleepy and she dozed off and on only to be woken by myself or a nurse to ask her how she was doing or check her vitals. She did get a 102 degree fever about an hour and a half after the dose was complete, but it's resolving itself and she seems mostly herself. We went for a short walk around the hospital and watched some funny cat videos on YouTube. Right now, she's sitting on the couch watching a movie before bed.
I think the medical staff is somewhat surprised. They came in frequently and seemed surprised each time. In a good way.
I'm told days 2-5 of Campath gets progressively easier as the patient's body gets used to the medication. I hope that's true. I'm sure there are rough days ahead, but the roughest thing about today was the anticipation.
Becky is still coughing pretty bad so she wasn't her today but we swapped texts, emails and phone calls so she was kept up to speed as the day progressed, but she didn't miss much. Her presence was felt though: she'd helped Elise pick out some bedding to put on the hospital bed to make it more like home. She also sent along a "How To Train Your Dragon" poster which Elise and I hung up. Elise is crazy about the new movie coming out and she's bummed that she'll miss it while she's stuck in the hospital. So she was happy to get the poster.
As for me, I spent the day working on a short story I started writing last week. It's sort of a scifi genre based on Hugh Howey's "Silo Series". If I'm happy with it then I'll publish it on Amazon under the Silo Kindle Worlds umbrella (it's set up for self publishing fan fiction writers). If even I don't like it, then it will be nothing worse than a good diversion and some exercise for my fingers. We'll see.
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