[Laron1969]

Engraftment on Day +5 during stem cell transplant?

by Laron1969 on Mon Apr 04, 2016 12:02 pm

First a bit of background about me: My wife was diagnosed with multiple myeloma in September 2015, only 3 months after I lost my father to multiple myeloma after 18 years of fighting. She is an incredibly healthy 39 year old mother of 2 kids, aged 5 and 7. Even today it all seems unbelievable.

She had 4 cycles of Kyprolis, Revlimid, and dexamethasone, which gave a complete response with normalization of all of her myeloma labs and no detectable disease in her marrow.

We sought guidance from myeloma specialists at Memorial Sloan-Kettering and Dana Farber, as we wanted to make certain we were getting the best treatment currently available.

As many do, we agonized over whether to proceed with transplant, and ultimately decided to move forward at the Medical College of Virginia here in Richmond. My father had 2 transplants here as well, so I knew some of what to expect.

My wife is now Day +5 and soldiering through all of the GI effects of high-dose melphalan and her counts have been steadily dropping, on schedule according to her attending physicians.

My question (finally): Her neutrophils went from 1.5 on Day 3 to 0.5 Day 4. This morning they were at 0.8, which I found surprising.

I am wondering if this is an aberrant number and she is yet to bottom out, or if she has en­grafted and her numbers will start to rise. It seems early in the process to have numbers heading back up. I expected several days of hanging around zero before they would rise.

I am grateful to others who have shared their transplant experiences here and have read them with great interest.

Has anyone else had an engraftment start on Day +5? I have not spoken with her physicians as of yet and am sure they will have additional insight.

Thanks so much, this is a wonderful resource for information and support.

[Laron1969]

Re: Engraftment on Day +5 during stem cell transplant?

by Laron1969 on Tue Apr 05, 2016 8:58 am

I spoke with the attending and this was just a fluctuation.

He did mention that some patients bottom out at around 0.5 before engraftment.

[JPC]

Re: Engraftment on Day +5 during stem cell transplant?

by JPC on Tue Apr 05, 2016 9:24 am

Good morning, Laron:

I do recall being advised by the medical team that the typical thing to expect is the have the white count go to zero, and come back after 1 to 3 days. If your wife does bottom out at a little above zero, it looks like an interesting case. I recall for my wife, it was on the second day that they came back (right in the middle, with no cause for undue or extra worry).

As I recall, the melphalan wipes out the marrow and the existing stem cell (the so called fast growing cells), and the existing whites die off according to their regular schedule. The fact that the stem cells come back two days after the whites go away make sense, because it's also two days after the new stem cells are administered after the melphalan. Normally, they are in a near equilibrium, where the rate of creation just about equals the rate that they naturally die off.

Thanks for sharing your experience, and good luck to your wife. Regards, JPC

[Music box lady]

Re: Engraftment on Day +5 during stem cell transplant?

by Music box lady on Tue Apr 05, 2016 8:33 pm

Hoping everything goes well with your wife. I had my transplant at Richmond in 2012. They have a great caring staff there.