Thursday, August 2, 2012

Graft Versus Host Disease (GVHD) and Steroids

On July 31, I was supposed to drop completely off the steroids I was taking. I had been tapering all month. I contacted Vanderbilt, told them how things have been, and they told me to go back up to 10mg per day, which is where I was at in mid-June.

In two days, I felt like I'd been born again. Mood jumped, appetite increased, and all the intestinal warfare stopped.

And warfare is the right word. Graft-versus-Host Disease (GVHD) is my new immune system attacking my body, in this case my gut, because it doesn't recognize it as a friend. Going back up to 10mg Prednisone got my immune system off my gut.

So today we asked about when we might be able to taper off the steroids safely. (I saw "we" because my wife, who is my caretaker, goes through all this with me and handles my medications.) I learned some things about steroids I didn't know, or at least about Prednisone, this specific steroid. I also learned some things about stem cells and about transplants being rejected.


Your body (but not mine), produces about 7 milligrams of steroids on its own everyday. The nurse tells me that because I've received so much steroids over the last year, my adrenal glands have "gone to sleep" figuring they're not needed. The taper, going off the steroids bit by bit, is to get my body to wake up and start producing its own steroids. Until then, when we may have to settle in at 7.5 mg and give my body what it's not producing. The 10 mg that I'm getting now I will only get for two weeks, then we'll stay at 7.5 for a while until we're ready to test my body again.

Transplants and Stem Cells

When a person receives a kidney, liver, or heart transplant, he or she must stay on immunosuppressive medicines all their life. Their immune system, if given full reign, will attack the new organ as foreign, and that will be as true 30 years from the transplant as it is on the day of the transplant.

Stem cells are not so.

Stem cells are more "plastic." They can be trained. So today my immune system (which is the real foreigner here), will begin attacking my gut and skin if it is given full reign. But because I have the stem cells that produced the blood system (and thus the immune system), the stem cells are learning. While the immune system is on a leash, the cells are learning whom they can live with and whom they can't live with.

Eventually, sometimes its three, four, or five years down the road, bone marrow transplant recipients can let their immune systems off the leash, it will have learned to recognize the patient's original DNA as not harmful.

Until then, the doctors let the immune system loose a little at a time, chain it back up when it snarls and bites, then let it off again later; testing ... testing ... until they get the patient off all immunosuppressives.

I'm on very minor amounts, and the stem cells I got were really stem cells. People with adult donors get "hematopoietic" stem cells, which are cells that can become any blood cell. I got cells from an infant's umbilical cord (no, not an aborted infant; donated by a wonderful set of parents after a live, healthy birth). They're completely naive, untrained stem cells, ready to make blood and learn how to take on the world.

People like me who get cord blood are in more danger the first 30 days after transplant because engrafting goes slowly, so we're completely without an immune system longer than those with an adult donor (or who are self-donors). But after 90 days, our new immune system usually gives us less problems than those who have adult donors. Wow, that would be nice. I made it past the "sorry, you're much more likely to die during these 30 days than those with adult donors" so I'm happy to try to reap the benefit of those little thriving baby cells.

This is just like being a parent. Getting those children to behave can sometimes be a real challenge.

Have a great day. Conquer every obstacle. Roar a lot when the going gets difficult. Trust God, and there's nothing you can't overcome.

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