Here we are in Starship Hospital, room 16, a room with a view and the perk of having the rescue helipad below our window. It's day -02 in our calendar so to shed some light we thought a overview may be helpful.
A bone marrow transplant (BMT) is a process in which damaged marrow is replaced with healthy marrow. Maximus is receiving an Allogeneic transplant meaning the stem cells are donated by another person who's tissue type is comparable with his.
In Christchurch we were told a BMT was only an option if his one sibling Matthias was a match. This significantly reduces the risk of graft versus host disease (GVHD), an immune system reaction commonly seen after an Allogeneic transplant. In GVHD the donors immune system recognises the patients body as foreign & attacks it (protecting it's new home). So a match he was minimising such risks.
We can break the transplant up into the following stages.
Day -12 - -02 CONDITIONING
Before receiving the transplant Maximus underwent 9 days of conditioning therapy. This is to make space in the bone marrow for the new cells. It is also used to suppress the immune system to reduce the risk of the donor stem cells being rejected.
We are currently on day -2, our last day of this stage. Our champion just had 9 general anaesthetics over a course of 6 days down in radiotherapy and finished chemo this afternoon. It has been very hard but our trust has been and is in Jesus.
Day 0 THE TRANSPLANT Tuesday 18/10/16
Our delightful Matthias will go into theatre at 7.30am where stem cells will be extracted out of his bone marrow. He may require a blood transfusion and some initial pain is to be expected so we will very much so be caring for him. The precious bag containing these cells are then delivered to Maximus's room.
Unlike Matthias's intrusive morning the transplant itself is somewhat straight forward. The stem cells are infused through a central line (to the heart) as were all his other blood transfusions and he could well be playing Lego at the time if able. These brilliant little cells then travel through the bloodstream until they find their way to their new home.
DAY 0 - roughly DAY 28 PRE ENGRAFTMENT
After the cells are infused there is a period of roughly 14-28 days where we are waiting for engraftment. This period can involve a lot of pain and severe sickness due to mucosisit. He will also have no immunity.
DAY 14 - 28 ENGRAFTMENT
The graft is starting show as indicated in the blood results. Mucosisit will begin to subside but other complications, infections, viruses and GVHD will now be closely looked out for as they only eventuate at this time.
RECOVERY
The immune system will take quite some time to recover so we'll have to take precautions to reduce the risk of infection.
30 - 60 days later Maximus will be weaned off immunosuppressant drugs (used to suppress GVHD) and the risk of infection will decrease as a result. These drugs can also make patients feel lousy so it's a milestone in more ways than one.
9 - 12 months. A fully reconstruct immune system.
After all that information we really want highlight the endearing bond between Maximus and Matthias.
They are always by each other's side. Maximus's is constantly getting smothered by Matthias's affection. It was Matthias who first made Maximus smile after he withdrew 2 1/2 years ago in Christchurch. As parents we have been known to extort this lovefest threatening Matthias with not being allowed to visit the hospital if he doesn't cooperate. This would be true deprivation therefore he always complies.
Lastly the name Matthias was never on our horizon as we were fond of Zion throughout pregnancy but during those 'interesting' hours of labor the name Matthias was mentioned and surprisingly chosen. The meaning of his name is 'Gift of God' and we can testify what a gift this child is and now especially to his big brother.
Zion is his middle name.
Strange fact. Maximus will have Matthias DNA as shown in future blood tests.
Love, thanks and gratefulness
The Mathews
