THE QUEST CONTINUES

Wednesday, DEC. 24TH; 3am
Christmas eve – we are planning on going to Jerusalem, the Holy City today. After ‘interviewing’ several taxis that we took previously, we chose a friendly ‘wife loving or is it fearing’ elderly gentleman who has visited Bangkok, of course staying at Khao Sarn Road for several weeks. During the cab ride and during the course of the conersation (interview) he made several calls to his wife to ask questions re their Bangkok trip (she remembers everything…he says with resigned admiration). This odyssey will begin later on today.
Monday saw Titi settling from his high fever again with a high flurry of activity centering around his ever-volatile condition…attempting to amass a large-enough data-base to find a window of stability in the near future to perform the transplant.
Because he had a stubborn pain in the buttocks, a visit to the proctologist was scheduled and the subsequent reports were maddeningly alarming. After the check-up and q and a with the proctologist, the following was evident – the attending doctor in Bangkok slept on her watch in this instance.
Titi had laser surgery several days before his departure from Bangkok. The surgery was performed with the intention of making the trip less painful – all good so far except we now realized that a proctologist was NOT consulted prior to the surgery. It was just between the hemato-oncologist and a surgeon.
The resultant effect was that layers of protective skin (there is a very large amount and cluster of nerve-endings and nodes collected near the scrotal area) where the laser tried to clean up was peeled away – the excruciating pain was the apparent result along with his apparent lack of neutrophils (an immunizing agent) in his blood. An ointment was ordered and delivered that afternoon and according to Titi, seemed to help.
The negative take away is that the protocol cannot begin until this condition stabilizes i.e. no fever and infection on the near horizon. The proctologist said that if it does not clear up within several days, another operation may be necessary!!! Prof. Slavin just had one comment on that – ‘just get well’ – he ordered Titi.
Brushing aside all the negative recriminations of ‘what might have been if the laser surgery had not been performed etc. etc.’ , the overall consensus in our group was to forge ahead with positive thoughts and concentrate on getting well soon.
In the meantime, on Tuesday, the preparation for the transplant had begun.
I was summoned to be at the hospital at 8am for registration and blood tests.
At nine am, the paperwork was complete and at 11:30 the bloodwork started.
( In the pix..blood flows out from the left and back into the system via right)
About 50 ccs were collected in vials and I was told to come back in 15 mins. for them to harvest about 100+ ccs of lymphocytes and 150 ccs of plasma. The preparation for the ‘killer cells’ combo of Titi’s and mine to overcome the blast cells had begun.
The process/procedure in theory is quite simple but Prof. Slavin warned, ‘the devil is in the details’.
Theory of the Procedure (Haploidentical Stem Cell Transplant – HSCT)
Prof. Slavin started off with a question:
“What if some 50 ccs of the blast (read bad) cells were taken from his body (Titi’s) and put into mine?”
Answer: My immune system would overcome and kill these baddies in no time.
On the other hand, 50 ccs of the good guys would not do the trick if similarly transplanted into the midst of the blast cells.
To drain the body of all white blood cells and then to find an identical (never 100% matching) donor would always be subject to 80% probability of system rejection of the donor’s cells – especially at Titi’s age and severity in the blast stages of this type of leukemia (CML). The ideal thing to do would be to have Titi’s existing immune system accept the good donor cells (half his and half donor – haplo), forge an alliance and kill the blast cells together. This is the theory – in a nutshell).
In order for that to happen, the procedure would have to temporarily freeze Titi’s immunity process in order for his body to adjust to the invasion of the good cells. This will be accomplished with a combination of drugs to suppress the existing lymphocytes and antibodies.
The good professor then goes on to describe a method of separating the killer cells (the immunity defenders) resident in the system. Separation of the good killer cells and the bad ones means nullifying the potential of the bad ones so that the good guys can have the time to join forces and kill off the baddies.
Concept is clear but the process is apparently fraught with risks of infections and sepsis. Prof. Slavin is an immunologist first among his many areas of expertise so he is very well suited to help Titi in this case.
The schedule is as follows: Respites for the patient (to continue the healing ‘down under’ ) and for the donor . Tomorrow– neupogen shots will start at 8am/8pm Christmas day for four days to culminate in the harvesting process on Monday the 29th. Hopefully, Titi can then be ready to start the protocol by then.

God bless us all with a Merry Christmas.