It’s DAY +29 and Kevin officially has Graft versus Host Disease (“GvHD”) of the skin. =(
GvHD is a possible complication of any Allogeneic Bone Marrow Transplant (from a donor). It develops because the donor’s stem cells (the Graft) see certain parts of the patient’s body (the Host) as foreign and the donor cells attack. The cells that attack are T-Cells.
T-Cells are a type of white blood cell that fight infections. T-Cells attack and destroy cells they see as foreign, and potentially harmful, such as bacteria and viruses. Normally our T-Cells do not attack our own body cells because they recognize them as our own based on the HLA (human leukocyte antigens) pattern.
Prior to the bone marrow transplant, a donor is selected based on the HLA typing. So the donor’s HLA is matched as closely as possible. However, there are always some differences and sometimes it is not possible to wait for a “perfect match”. Kevin’s donor was not a perfect match. He or she was a 7/8 mismatch. So we knew going in that some form of GvHD would develop. We just hoped that it would be relatively mild.
The donor cells can attack any part of the body, but most commonly they will attack the skin, digestive system and the liver. There are two types of GvHD:
Acute GvHD typically starts within 100 days of transplant. The symptoms can be mild to severe and in some cases, life threatening. Immunosuppressant medication and a number of other treatments usually helps to control and reduce the severity of Acute GvHD. The hope is that eventually the patient can be weaned off of the drugs and treatments and eventually the Host and the Graft will get along.
Chronic GvHD, generally starts after the Day +100 milestone. Again, the symptoms can be mild to severe and in some cases, life threatening. Chronic GvHD can last months, years and even a lifetime.
Although GvHD can be extremely difficult to cope with and really, really SUCK, there are some possible benefits, especially for a blood cancer patient. (See… there is good and bad in everything!!) If there are any remaining cancer cells in the body, the hope is that the donor cells will find them too and destroy them.
So Kevin has what would be considered pretty serious GvHD of the skin. About 50% of his body, including his head, face, neck, shoulders, back/torso, wrists and hands are covered in a rash that looks similar to this:
Kevin’s face also looks like he has a really bad sunburn and it’s super puffy. I took one look at him this morning and thought, “HOLY CRAP!” I feel so bad for him! He also has some stuff happening in the back of his throat and a bit on his legs. He is being treated with high dose steroids and some other medications to manage the side effects. We were told that there is a 50% chance that the regimen will control the severity of his GvHD. His Tacrolimus (immunosuppressant) level also dropped significantly, so that was adjusted too. We have no idea why it took a nosedive, but hopefully it will rise and help keep those aggressive T-cells in check!
So the better part of our day was spent in a hospital. Like I’ve said over and over again, a bone marrow transplant is a pretty intense and insane medical process. Although we have informed ourselves about what to expect, nothing can fully and TRULY prepare you for this stuff. It’s brutal and it’s scary. You just have to make the best of it so it never gets the best of you and force yourself to keep focusing on the positive, the blessings and the humor. Even when what you’re going through seems insurmountable, you must KEEP GOING!
There is one thing I do know for sure! We could not get through this without all of the love, laughter and support from you, so thank you for that!