Day +10: Expectation management

About a week ago, a clearly excited transplant fellow Dara poked his head around my door and told me, among other things, that the lady in the room three doors down from mine had engrafted on Day +10. A few days later, he told me she was going home.

On the one hand, it was great to hear of such success – it’s encouraging to know that when they talk about engraftment happening at some point between Day +10 and Day +16, the full range is actually possible. After all, you barely dare hope that your own engraftment will occur at the start of that, and doubt that many get there so soon; it’s good to get proof that’s it’s possible. It’s also just lovely to hear that fellow patients are doing well, of course.

On the other hand, the fact someone down the corridor managed to engraft so soon doesn’t really have any bearing on your own situation, and provoke an absurd feeling of competition. Then you might start getting overexcited about the possibility that you’ll be able to match your fellow patient, causing you to focus your attention on Day +10 as the target, rather than an undefined day between then and Day +16 – potentially morale-sapping if your day doesn’t come until nearer the end of the range. Or you might fear that the law of averages will ensure you don’t engraft before Day +16, just to keep in line with the stats.

Fortunately, though, and very excitingly, my engraftment was officially declared today, on Day +10, after I registered neutrophils for two days in a row. They’ll have to find someone else to balance the statistics… After my mouth felt a bit better yesterday and I generally felt fairly well in myself (bar a continuing sore throat), I wasn’t all that surprised to learn I had managed to reach a neutrophil level of 0.3, thanks to the new stem cells. There are good reasons why they don’t declare engraftment until the feat is repeated, though, so I kept quiet and hoped for a good result this morning. And there it was: 1.4!

The next step is to stop the G-CSF growth hormone at some point over the next couple of days, to see how successfully my counts hold up without the extra encouragement. Effectively, though, the presence of neutrophils means that the transplant was successful – though of course it needs careful management for quite a while yet. Thank you, donor! I probably won’t be able to go home for at least another 11 days, as I’m due to keep getting the defibrotide four times a day until Day +21, but even that doesn’t seem very far off now that we’ve reached such an important milestone.

So it’s been a very exciting day – topped off by Freddie’s arrival in the UK from Vancouver. I was, of course, secretly hoping that my stem cells would engraft so soon, but I was prepared for it to take longer.

Another chapter opens, but for now we’re going to enjoy the last moments of a wonderful Day +10…