Graft Versus Host Disease

The next few days in the Cancer ward were pretty unceremonious. No sleep, docs and nurses in and out, a few family visits and phone calls with the store, Lor and big Nick. After all, I had only seen Nick twice for about an hour and our new baby Joe only for an hour after he was born. I needed to get better. My blood counts were increasing again with the therapy given to me as well as the lowering of my temperature through the antibiotics. The trend was positive so far. Hopefully, by the end of the week, I will be headed home again.

While I was recuperating in my room, Dr. Dave came by and we had a long discussion about the reason that he kept me in the hospital and could continue to bring me back. GVHD… Graft Versus Host Disease. Dave had mentioned this before in our initial consultations but we would now delve into the dangers and importance of this phenomenon. GVHD was a two pronged sword. A natural and necessary byproduct of a Bone Marrow Transplant. As much as you needed to get it, it could also kill you. It needed to be managed carefully although there was not much control that you could have over it. Disconcerting to say the least. So what is GVHD?

As defined by Explore cGVHD… “Graft Versus Host Disease is characterized by a combination of tissue inflammation and fibrosis, which manifests itself across multiple organ systems”. “Fibrotic lesions can develop across multiple organs where Fibrosis is a major contributor to life threatening complications and significant morbidity. Patients can develop multiorgan manifestations, including skin, mouth, joint, eye, GI tract, esophagus, liver and lung manifeststations”. In layman’s terms in regard to my own personal case, I needed to get GVHD as a means of destroying any original remaining bone marrow while allowing my donor marrow to proliferate. The fight that occurs inside my body between the donor DNA and my own DNA has to be somewhat significant as the original DNA will try to grow back. That fight is the premise and cause for the Graft- the donor marrow VS the Host- my marrow. This must occur, but the degree of occurrence enables the outcome. The Host DNA must be obliterated with no ability to return. Got it so far? It is pretty interesting.

Bottom line was that I needed to get GVHD. It could be mild to almost no GVHD. This was not what Dr. Dave wanted. With very little or no GVHD the transplant could revert itself leading to almost certain relapse. It could be slightly aggressive but manageable. This would be the best case scenario. A manageable case would be uncomfortable but offer the result most likely to afford me a successful lasting cure. Lastly, it could be very aggressive. This would be bad. Uncontrollable GVHD would most certainly lead to prolonged disability or death. This discussion with Dr. Dave was more enlightening than previous but most necessary. He would be watching me very carefully as we discussed the symptoms and signs of GVHD progression. The anti rejection drug that I was taking also played a huge part in the outcome. The dosages had to be conditioned to allow for the occurrence of GVHD to the extent that it would be conducive to a successful transplant and make sure that my body accepts the new marrow. This drug along with large doses of steroids would be the course for now. GVHD symptoms can range from skin rashes to joint issues, Ocular dysfunction and Lung function impairment. The latter resulting in significant morbidity. It could also lead to significant psychological distress. Chronic GVHD could also result in disability which could make returning to work at least two to three years or more a reality.

Ok, Dr. Dave. Such a wealth of information he was. I guess that’s why he was the best. He never pulled any punches. Like me, he believed in the reality of a situation. You can sugar coat any opinion, belief, story or situation, but reality is always what it is… the truth….like it or not. I was glad he was my doctor. He kept me informed no matter how bad the reality was. This was a nasty fight. Round 1 was getting through the diagnosis. Round 2, the actual transplant. This was Round 3, surviving the aftermath. Dr. Dave was Mick. The Manager, Trainer and Cut man. I was Rocky. Being Rocky sucks. Round 3 sucks. They all sucked.

Next up: Helpless