BMT Day +7

We are officially one week post Nathan's BMT. This means that we are done with all chemotherapy medications and just waiting for engraftment to occur. For a bone marrow transplant patient, so much is measured from day zero. Days prior to transplant at "negative" numbered days and days post transplant are "positive" numbered days. I imagine for a good portion of his childhood, we will be counting the days, months and years post transplant as much as his own birthday. The significance of "Day 0" is tremendous to the point that I cannot possibly list all the reasons here but suffice it to say that his transplant will have lasting effects through the course of his life. 

I know lots of other families dealing with bone marrow transplant for aplastic anemia scour the web much like I did in order to kind of know what to expect. I also know that the circumstances are so individual and variable and also depend largely on the conditioning method used. Nathan's conditioning "roadmap" included several chemotherapy medications prior to transplant to clear out his own system and prepare for the new cells, as well as a few very small doses of different chemotherapy meds post transplant to try to reduce the risk of GVHD (graft vs. host disease) and common viral infections like EBV (Epstein Barr Virus). Here is his roadmap in detail, this only includes the major medications used in his conditioning and not the other medications used to mediate side effects or other issues he is having aside from the transplant.

• Days -6, -5, -4, -3: Chemotherapy Pre-Conditioning with Fludarabine, R-ATG and Cyclophosphamide/Cytoxan along with Mesna to protect his bladder from the Cytoxan and Tacrolimus (similar to Cyclosporine) for continued immunosupression for approximately a year post BMT
• Days -2, -1: Rest 
• Day 0: Bone marrow Harvest and Transplant Day
• Day +1: Methotrexate (GVHD prevention)
• Day +3: Methotrexate (GVHD prevention)
• Day +5: Rituximab (EBV prevention)
• Day +6: Methotrexate (GVHD prevention)

As I have said before, I am surprised by how smoothly the pre-conditioning phase went. He was very sleepy on days -5 through -2, likely due to high doses of benadryl as much as chemo effects. He felt sick and had three bouts of vomiting on days -4 and -3. He started to bounce back by around day 0 and has been increasingly active ever since, certainly nowhere near his old self but still we spend a good amount of time in the halls every day walking and playing with his beach ball or in the room playing board games and doing crafts. He loves spending time with the volunteers and the music and art therapists too.

On the evening of day 6, we noticed his hair starting to fall out and will likely shave his head (per his request) sometime over the next few days. Nathan hasn't had any mucusitis or any other major post-chemotherapy effects to date and I am told it is unlikely that he will at this point just due to the time that has passed and the "reduced intensity" regimen that he has had. His liver enzymes have gone up a bit due to the recent methotrexate doses but that is normal and the numbers will go back down as quickly as they went up. The only other not so great effect is that he is consuming platelets rapidly once again likely due to the ATG but that also should be just a temporary issue that will remedy itself just like it did the last time he received this medication. Now we just have to wait for the new cells to grow which can begin to happen as early as day 10 or as late as day 24, and then hope there aren't any major complications following engraftment so we can finally start planning to go home.