Not more than a few hours after being released from the hospital, we received word about Idan’s chimerism test results. They were not as good as we would have hoped, but they did not confirm our worst fears either. Instead, it seems that Idan’s donor t-cells have held their ground at 7%. Two of his other cell lines (the NK-cells and B-cells) are even edging up in favor of the donor cells. While it is still too soon to predict what this means for the outcome of Idan’s bone marrow transplant, it seems that the graft is holding on. What we do not know, however, is how long the t-cells can hold on, and whether they will ever rise above 7% without intervention. If they do not reach at least 20% (but better case scenario is 100% of course), then the entire transplant is a failure, even if every other cell line perfectly engrafts. So, in an attempt to save the graft and give the donor t-cell’s a boost, we are moving forward with the DLI on December 24th. The DLI is essentially an infusion of the donor’s lymphocytes (i.e., t-cells) directly into Idan’s blood stream. These are mature t-cells, so we think they will be better equipped to fight off Idan’s old t-cells and can help clear more room in Idan’s bone marrow to allow the *baby* donor t-cells to thrive. We hope to be in the hospital for only one day for observation, but it could turn into a longer hospital stay depending on how everything goes. The DLI poses a risk for graft versus host disease, so we will be watching Idan even more carefully over the next few weeks.
As for Idan’s fever, we still do not know the cause. It broke some time on Sunday afternoon after a new antibiotic was started. However, every test imaginable (short of invasive imaging or the like) showed no infection. That said, these tests cannot test for everything, so there still could be an infection lurking somewhere, which would make sense given the timing of when Idan’s fever broke. We hope that the antibiotics did the trick then. Another possibility is mild graft versus host disease, which can be brought on by an increase in the donor cells. We now know from the chimerism tests that Idan’s donor cells did increase (even if at the same rate as his own cells), so this is definitely a possible explanation. The truth is we may never know what caused the fever, but we hope we have seen the end of it!
And in his never-ending quest to make sure we all keep laughing and smiling despite the bad days, here are a few clips of Idan that we think you’ll enjoy almost as much as we enjoyed these sweet moments:
All our love,
Amanda, Akiva & Idani