Brianna's White Count Drops, Graft Failure Possible

All last night I prayed that Brianna's white count would rise today, and I believed it would. After all, she was off the Sirolimus for seveal days now. But when I heard that it had dropped again to 0.3, a flood of tears came from me. Thankfully, I was at the nurse's station when I learned and not in the room. I had told Brianna that I was going to get coffee and I left so I could call my husband and sob.

It seems that we are not getting a break, no matter what it is! When I told Brianna, we held each other and cried. I got into her bed with her, held her and tried to comfort her. But, I was feeling beaten down too, and I'm not the one who has been coughing up spots of blood and having a side that is very painful due to fluid build-up around the lung and who has to live with this for the rest of her life.

So at this point, our main concern is no longer her lung, but the marrow itself. Her white count is the best defense against the fungal infection. But that has not gotten better and in fact has gotten worse. The question of whether the new stem cells are present in her marrow and have multiplied is the big issue. If so, then they are still being surpressed by one of the drugs she's on. If not, then obviously the cells did not graft and she needs another infusion of donor cells.

There are two reasons grafts don't take. One is that the body's own immune system has rejected the new stem cells. In Brianna's case that is really hard to believe because she's gotten radiation and chemotherapy to kill all her immune system. The second reason for a failed graft is that the new stem cells take a hit by an invading virus and are so depleted, they do not recover. Thus, a rise in white count and then a continual dip. So far we're awaiting a test results to rule out the virus.

The true test though is to see what's going on in her marrow. So this afternoon, she'll be getting a bone marrow biopsy. The doctors will be able to see a very preliminary smear on a slide several hours after the procedure and let us know what they find. But the real story will be found in the bone core and when its de-calcified. It should tell us what cells, if any, have made house there. If it's empty, then more stem cells are needed. If the marrow has lots of healthy cells, then the cell production is still being suppressed by some other drug she is taking. Of course, Brianna's primary worry is that she'll have to go through the terrible experience of radiation and high dose chemotherapy again. That is a worry of ours too.

In the meantime, we've requested that the donor be contacted immediately to ensure her availability. She is an international donor and we worry that with the time difference and distance, we may not get more stem cells soon if she's not contacted right away. Of course, we also have to hope that the donor is kind hearted and willing to go through the process again for us.

In clinical terms, if Brianna's counts are going down on Day +29, it means her graft has failed. Getting more marrow will be a priority. As for her lung, she's in such a tenuous position and the likelihood that she will need surgery to remove a portion o it looks more and more like a reality.

I am at such a loss, I cannot even say how sad I feel. That we have had to face every obstacle that usually happens to only a small percentage going through transplant is unbelievably frustrating. Brianna is doing what she has to in order to get well. Her spirits are not high, but she has not hit rock bottom. I'm afraid that is where I am. Writing this blog to keep you all informed is very helpful, and it is therapeutic for me. I know I sound as if I have lost my faith, and maybe I have. But I must at least be strong for Brianna and that is what I am doing in her presence. But if you look for me when I'm out of her room, don't be surprised if my eyes are red and I am wiping my nose. This is the hardest thing we have ever had to face.