Day -3

No major changes from Day -4. I’m still on Busulfan every 5 hours and luckily have experienced no side effects other than a slight darkening of my skin, which will gradually disappear, and a feeling of being hot all the time. Fortunately my room has it's own thermostat.

Tomorrow at 6:00 AM I will be introduced to my first dose of Cytoxan (Cyclophosphamide) which will be administered via IV drip. Cytoxan is given in very high doses (once a day over 1-2 hours) for 2 days before an allogeneic transplant (getting bone marrow from another person) to kill any cancer cells that remain and to make room for new bone marrow to grow, then again on days 3 and 4 following my transplant in order to prevent Graft-versus-Host disease.

Graft-versus Host (GVHD) is a common complication following an allogeneic transplant. Twenty to 50% of patients with a related HLA-matched donor develop GVHD which is typically triggered by cells called T-cells. T-cells are a type of white blood cell that recognizes which cells belong in an individual’s body and which cells do not. When a donor’s T-cells are transplanted they perceive the patient’s organs and tissues as foreign cells and orchestrate an immune system attack to destroy them. Fortunately, most patients transplanted with a matched related donor experience only a mild case of GVHD that resolves itself over time with treatment. But of those with a more severe case of GVHD, managing this potentially life-threatening complication can be a serious challenge. There are lots of nasty side effects of GVHD but I'll let you know about them later if necessary!

For each dose of Cytoxan that I get I will receive 4 doses of a drug called Mesna that helps to protect the bladder wall – one before infusion and three after. Bladder irritation is very common with Cytoxan so IV hydration is a very important aspect to protect and flush the bladder. High-dose chemotherapy is toxic to normal tissues and organs, as well as diseased cells. Nausea, vomiting, diarrhea, mouth sores (mucositis), throat sores (stomatitis), a burning sensation in the nose or sinuses, a lowering of blood cells (putting me at risk for infection and bleeding), and hair loss (alopecia) almost always occur to varying degrees, probably one week after transplant. While organ damage (liver, lungs, heart) can occur, it is usually mild and completely reversible. There are several other possible side-effects, but since they're not likely to occur, why fret over them now!

Let’s pray that I’ll do as well on the Cytoxan as I did on the Busulfan. I’ll fill you in tomorrow.