On the 8th, Kurt saw his hematologist/oncologist for an appointment. Since there wasn't a biopsy after the last cycle, there wasn't much news to relay. We did get a chance to ask and have some more questions about transplant answered. Transplant is such a BIG thing--we always have new questions pop up and want to try to be as prepared for what it will be like as possible. Our plans are still the same regarding a timeline:
-If Kurt's next biopsy (probably around January 1st is MRD Negative (0 Leukemia cells)), he will proceed to the prep for transplant. This will include organ function testing and the placement of a Trifusion catheter to replace his PICC line. The Trifusion will provide three lumens for more access points than the two on his PICC and is a bit safer and less cumbersome than the PICC line. Placement does require mild sedation. He will most likely have the Trifusion in his chest until at least 100 days post transplant.
-We were told that if he is cleared after the biopsy, it will probably be 2-3 weeks until transplant begins. Some of the timing depends on the donor. The donor's stem cells will need to be harvested and transported to UK before Kurt begins "conditioning."
-"Conditioning" for transplant will be 5-7 days of intense chemo in the hospital counting down to "Day 0" when Kurt will receive his new stem cells. The purpose of this part of the regiment is to obliterate Kurt's own bone marrow to make room for the new stem cells. He will have intense chemo and radiation. Current chemo simply is enough to kill the Leukemia but allows the bone marrow to continue functioning. "Conditioning Chemo" will be so strong it will permanently damage Kurt's bone marrow to the point it can no longer work properly, allowing the new stem cells to engraft and take over.
-During transplant, we expected to be in the hospital for 4-6 weeks. Engraftment generally starts to take place around day 10. Kurt will probably experience some degree of of Graft vs. Host Disease (where his new stem cells attack his body). This usually manifests in skin, mouth, and gut issues. Some degree of GVHD post transplant is a good thing as it creates a "Graft vs. Leukemia" effect where the new cells fight any remaining Leukemia cells! However, we don't want GVHD to get out of control and actually cause harm to Kurt's body either. It's something that is carefully watched, especially during the first tenuous weeks.
-For the first 100 days after transplant, Kurt will be on immunosuppressant drugs. If all goes well, on day 100, he can begin weaning off of those drugs, giving his new immune system a chance to really start to work and defend against germs! We will have to continue to be extremely careful during that first 100 day period of his recovery. For the first year after transplant, Kurt's immune system will still be like that of a newborn baby. We will have to be careful, especially with the COVID situation but we look forward to this healing process and getting closer to see those we love in person!
-If Kurt is not at 0 after this next biopsy, the plan is to do a round of the drug Blincyto for 28 days. Blincyto is not a chemo drug. It is a pre-programmed antibody that binds to certain markers on the Leukemia cells and destroys them. It is a revolutionary drug that we have heard great things about, getting many patients to 0 for transplant. For this medication, Kurt would do 7 days inpatient to make sure there are no reactions or side effects and then come home with a pump that would administer the drug 24-7 for the reminder of the 28 day period. We would then do another biopsy and proceed with transplant at that time.
-The great news is that there have been many donors identified for Kurt. Praise God! His doctor will choose the best fit for Kurt based on HLA typing. Male donors are preferable because many women who have given birth have additional antigens from their children. They also like to match blood type when possible. The more ways Kurt and his donor can be compatible reduces his risk for severe or chronic GVHD.
During this whole process Kurt has also been receiving spinal chemo through lumbar punctures (similar to an epidural). To administer the spinal chemo, a small amount of CSF is taken out to "make room" for the chemo (because the CSF system is a closed system, some must come out before more can go in). This allows the doctors to test the CSF for Leukemia cells. ALL is a tricky cancer and is prone to relapse in the CSF. We are so thankful that Kurt's CSF has remained clear of any Leukemia cells. His doctors had a goal for him to have at least have 8 spinal chemo treatments and Kurt completed his 9th Lumbar Puncture on Thursday. He will have one more, for a total of 10, on Monday. This should be the last one! He had some pain from scar tissue with the previous two LPs, but God showed mercy and answered our prays on Thursday. There was no pain!
If all goes well and Kurt clears the Methotrexate from his body, we should head home on Monday. I am so thankful that I am able to be with Kurt during this round of chemo. COVID restrictions at the hospital are tight, but we are so grateful that they are still allowing one visitor per patient on the Markey floor. We have also been able to walk the halls from 8-11PM. I think Kurt really enjoys getting out (I can go down for food, so I usually get one walk in a day to pick up dinner). We wear our eye shields and masks and get a little exercise. Tonight, we counted 8 doors labeled "BMT." 8 people going through the incredibly scary and taxing process of a transplant. Please pray for those 8 patients, especially as we know this is a lonely season for many of them.
Thank you for continuing to support us in prayer and through your generous gifts and service to our family. We can never express how grateful we are: meals dropped off, cleaning supplies, toilet paper, treats, gift cards, even help for Grandma and Grandpa when van battery died! We are so loved and so thankful for our families and our friends. We will continue to update you as we draw closer to transplant and we are praying that God will provide full healing and a cure for Kurt through this miraculous process.
With much love,
K and P
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