Day +43 - Chimerism and other Lab Tests

Since being discharged from the hospital, I've been returning each week for bloodwork and an appointment with my care team (my nurse practitioner and/or oncologist). Dana-Farber is amazing at the speed in which they process lab results. There's usually an hour between lab appointment and exam, and before I'm called into exam, most of the major lab results are in. (Sometimes that's not a great thing as I see it immediately in my portal without the aid of the professionals to interpret the results.) In theory, a visit could be as short as 1.5 - 2 hours. Unfortunately, each week, that seems to get extended for some reason. The first week, we added about 3.5 hours to get  blood and platelets. The second week it was to be sure I had no fungal infection - so we added on a CT and MRI appointment. Last week, some elevated lab work led to a quick kidney ultrasound.

Whose Cells Are They Anyway?

We'll get to the lab work, but I wanted to start with the cool test - the molecular chimerism test. Biologists a out there, please correct me if I get this wrong, but as I understand it, using my donor's DNA and my DNA, they evaluate my T-cells, granulocytes and one other cell type (which escapes me now and is no longer available for me to see on my portal) to see what percentage are my cells versus my donor cells. Right now, my T-cells are 84% donor and my granulocytes are 99% donor - which is exactly where they're expected to be right now.  It's just over six weeks since the transplant and the stem cells are making a nice little home in my bone marrow, churning out all the cells they're supposed to. That's pretty damn cool!

What's neither cool nor exactly where they are supposed to be are my creatinine levels (measures kidney function) and my potassium level (too high). There are theories for both, and it all may be related. The creatinine might well be affected by the tacrolimus, an anti-rejection medicine, I'm taking to prevent Graft Versus Host Disease (GVHD). For some patients, it just seems to affect kidney function more than others. So what do we do? Well, we start by cutting the tacrolimus dosage by half and will evaluate at Monday's appointment to see if that's had an effect. If that doesn't move the needle, we'll talk about switching back to another anti-rejection medicine.

The high potassium may be related to the fact that my kidneys haven't exactly been bringing their A game. But it also might be something as simple as my diet. In a world where things weren't tasting so good, bananas and protein milk shakes (with bananas) were daily staples. Add in some of the other high-potassium foods I've been eating and that could be the answer. So we gulped down a lovely little medicine to help get rid of some of the potassium and changed the diet up. We'll see what the numbers say on Monday.

Keeping My Mind Active

In the meantime, it's been a good week. Since Monday, I've had good energy and have started returning to work 2-3 hours a day, something I'll continue for the next few weeks. It's been such a mental boost to do so. For one, it gives a little structure to my day to have a couple zoom meetings (though I hope not to go back to my 8-10 daily zooms anytime soon!). But more importantly, it gives me something to concentrate on; something for my mind to do. Since the first couple days in the hospital, boredom has been my constant companion, work is a welcome respite. 

We'll see what the numbers look like on Monday. If we have normal lab results, maybe we can have a quick day in Boston. It hasn't worked out that way yet for us. Maybe Monday will be a first.

--michael