HAPPY EASTER

Today is Easter Sunday. Brendan had his last dose of chemotherapy this morning. The Easter Bunny left eggs all over his room and during the day he left special surprises in the two-way cupboard that allows access between his room and the ward hallway.

The chemo and the radiation have started to take effect. While Richard and Brendan were organising an Easter gift for the nurses, Brendan felt ill and then vomited toxic vomit all over the nurse’s Easter eggs. Luckily, Mum brought two bags just in case. Brendan is refusing to eat so has started on 24 hour naso-gastric feeds. He is on large amounts of IV fluids to protect his bladder and flush the chemo from his body. Even having a shower wears Brendan out. He is sleeping on and off during the day. Overall his emotions are more stable since going off the high doses of steroids he was on. He is happy and chatty (though such times are becoming less frequent). Brendan is very easy to read when he is feeling OK: he sits in bed chatting to whomever is around; when he is unwell he hides under his blanket and tells you how he feels but mostly wants to be left alone. His favourite phrase is ‘GO AWAY’ when he fells unwell. He never whinges and has a great medical vocabulary - just now he is discussing the side effects of chemo with his nurse.

Brendan has been having lots of fun showing his nurse his favourite “You Tube” sites. His favourite is a song about banana phones sung by Harry Potter puppet characters. You can find it at: www.youtube.com/watch?v=JKf7pPj6T7M . It makes him laugh each time he hears it.

Lots of people have asked us about how Brendan’s transplant is going and how it will be done. What we understand is that the chemo and radiation have destroyed Brendan’s marrow. Without a transplant, the chemo and radiation doses he has received would be fatal. Brendan’s marrow space is “empty”. Now that Brendan’s marrow has been destroyed, the plan is that it will be replaced by new marrow which will grow from the cord blood stems cells he will receive on Tuesday. Cord blood will be given to him through his central line. The stem cells in the cord blood somehow know to go to the empty space in Brendan’s marrow. Some time over the next 10 to 35 days we will hopefully see signs that his marrow is beginning to engraft. First we will see a rise in his white cell count and his neutrophil count. This means that all is going to plan. Until Brendan’s marrow begins to recover, he is in danger from a multitude of issues. He could reject his new marrow or he could have no marrow recovery at all and the transplant could be a failure. The list of concerns and issues goes on forever; we really have to take each day as it comes – one step at a time. We are only at the beginning of a very complicated and worrying process. Every day will be a new day. Brendan will be given blood products to replace the blood he is not making. His own body is a major threat: all the bugs that normally live in harmony in his body could take the opportunity to take-over and make Brendan very sick.

Everything is going to plan for today. Tomorrow, Brendan can rest and recover a little before his big day on Tuesday.

Happy Easter to all our friends and family
Cheers from Anna





















I have added an information sheet on Stem cell transplants for anyone who is interested:

FACT SHEET STEM CELL TRANSPLANTS

A stem cell transplant (also called a peripheral blood stem cell or bone
marrow transplant -BMT) is a medical process used to treat a range of life
threatening diseases, including leukaemias, lymphomas, myeloma and other
serious blood disorders, and some solid tumours.
•
The purpose of a stem cell transplant is to either cure, or induce a long-term
remission of a disease.
•
A stem cell transplant involves replacing the primitive blood-forming cells (or
stem cells), usually found in the bone marrow with healthier stem cells. It is
from these cells that our blood cells (red cells, white cells and platelets)
develop. Stem cells may need to be replaced because they have been
damaged as a result of high doses of chemotherapy or radiotherapy in order
to treat the underlying disease. High dose therapy may be used to treat
disease more effectively, giving some patients a better chance of cure or long-
term remission. Stem cells may also need to be replaced if they are diseased
(for example in leukaemia) or defective (for example in aplastic anaemia).
•
Stem cells can be collected directly from the bone marrow, from the
bloodstream or from the umbilical cord blood of newborn babies (cord blood
transplant). In most cases stem cells are collected from the bloodstream via a
large vein.
•
Unlike a solid organ transplant (for example a heart or lung transplant), a
stem cell transplant is not a surgical procedure. The stem cells are given as an
infusion through a vein (intravenously), like a blood transfusion. From here
they make their way to the bone marrow where they recommence the
processes involved in blood cell formation.
•
Transplants can be autologous – where the patient is their own stem cell
donor, or allogeneic – where the stem cells are donated by another person
(a stem cell donor).
•
In an autologous transplant the patient’s stem cells are collected in advance,
frozen and stored and returned to them after they receive high doses of
chemotherapy. Most people have a single autologous transplant. Others may
have two or more autologous transplants, over a period of a few months. This
approach, called staged autologous transplantation, is used to help reduce the
chance of some diseases coming back (relapsing) in the future.
•
In an allogeneic stem cell transplant the most suitable donor is usually a
family member, often a brother or sister whose stem cells are as close a
genetic match (tissue type) as possible to the patient’s. This is called a related
or matched sibling donor transplant. However, only about 1 in 3 patients has
such a donor, so the donor may be an unrelated, but matched volunteer. This
is called a matched, or voluntary unrelated donor transplant (MUD or URD). If
an exact match with the patient’s tissue type cannot be found, a partially
matched donor can sometimes be used.
•
A mini-allogeneic stem cell transplant (also called a reduced intensity or
non-myeloablative transplant) uses lower and therefore less toxic doses of
chemotherapy and radiotherapy. This may be an option for some older
patients, or those with certain health problems who cannot tolerate a standard
allogeneic transplant.

Over 1,000 stem cell transplants are carried out in Australia each year. The majority
of these (over two thirds) are autologous transplants.
•
Stem cell transplants are carried out in specialised transplant units in metropolitan,
and in some regional hospitals (autologous transplants only). Care is provided by a
group of specially trained doctors, nurses, social workers and other allied health
professionals who together, make up the transplant team. Most metropolitan
hospitals have nurses called transplant coordinators who will help make
arrangements for the transplant.
•
Allogeneic transplants are associated with significant short and long-term risks. The
risks increase with age so they are generally only offered to people under the age of
60 years (a mini-allogeneic transplant may be offered to an older patient).
Autologous transplants are less complex and generally carry fewer risks. The
degree and severity of complications and side-effects depends on several factors
including the type of transplant and high-dose therapy used, the age and general
health of the patient and the stage of the disease being treated. The time to
recovery varies but may take as long as 12 months. During this time the patient will
see the doctor on a regular basis.
•
There are separate Leukaemia Foundation booklets called ‘Understanding Autologous
Transplants– A guide for patients and families’ and ‘Understanding Allogeneic
Transplants – A guide for patients and families’, which provide more information on
these types of treatments.
For further information, booklets or support, please contact the Foundation:
1800 620 420 or www.leukaemia.org.au
Updated: September 2007