T + 1

Yesterday, in addition to my auto, there were 2 other transplants yesterday 1 girl 27 with leukemia whose sister was her donor and another gentleman with a match unrelated donor (MUD).

No problems for me overnight or am. Apt @ 7 am for 2 liters of IV fluids over 6 hours. All of my blood counts are even with or better than transplant morning.

My stem cells that were transfused yesterday are immature white blood cells that have the ability to develop into white, red, or platelet cells depending on what my body needs. Today the waiting begins for engraftment. My stem cells will circulate in my bloodstream for several days. In addition to the ability to form different blood cells, they have the ability to engraft in my bone marrow that is dead now or will be soon from the chemo and bring it to life to create all the types of blood cells that I need. With the auto transplant it takes about a week to engraft. They will continue to monitor my blood daily. At day six I will begin taking Neupogen shots again (at the clinic this time) to put the creation of stems cells into overdrive again to get them up to the normal levels.

My blood counts typically will continue to drop in the next week. I am encouraged that they did not today. As the white count drops I will become at high risk for infections. I am also at high risk from a neutropenic fever. 100.5 oF is the danger point. Many people develop mucositis or thick mucous that does not allow them to swallow. One of the chemo drugs VP-16 puts me at high risk for this. Any of the above or vomiting or diarrhea that cannot be controlled will send me back up in the hospital. 95% of the transplant patients are hospitalized for some of the above. I hope to be in the 5% to avoid that. If I can make it a week (till next Friday) I should be in the clear. For now its 6 hours in the clinic getting fluids (I do a pretty good job of that on my own), but vomiting diarrhea, and mucositis keep many from being hydrated. After a week, it will likely reduce to 1 IV bag over 3 hours which will be much improved.

I will continue to fight.

Mark