Top Line: with the MAC brought under control, meds levels readjustment led to a rocky GVHD patch, but the protocol has finally been tuned to where Susan is feeling decent.
First, two Dana Farber visits and a big anniversary have slipped by without having been blogged. Mea culpa. Mea maxima culpa. If I were my sister, I’d dock my pay and put me on notice. I’ll try to be even more wordy than usual in this posting to compensate for the shortfall.
So, what did you miss while the blogmeister was asleep at the switch? Disregarding chronological order, let’s celebrate (a day late, a dollar short, and after the fact) the third anniversary of T-Day. Don your party hats and grab your noisemakers. Now, look silly and make noise in recognition of this milestone. The further in time Susan is removed from the date of her transplant procedure, the more auspicious it is for her long-term health, chronic GVHD notwithstanding.
Now speaking of GVHD, you may remember that Susan had developed MAC (mycobacterium avium complex – say it fast five times) a tuberculosis-like disease, for which she was being treated with a drug protocol that interacted in somewhat unpredictable ways with her usual meds regimen, requiring a bit of trial and error to get all the factors tuned properly.
More specifically, doses of her two major GVHD medications – prednisone and tacrolimus – had to be roughly doubled during her treatment for the MAC attack. When she was pronounced ready to discontinue the MAC stuff, her docs reduced her other meds back to more or less pre-MAC levels, with the intention to reduce dosages further over time as her condition allowed. For those concerned with the timeline, this was the first unblogged DFCI visit and took place a couple/few months back.
Then came the anniversary. But even before the anniversary, Susan was not doing well. Resurgent GVHD, manifested primarily in the mouth, eyes, and skin, was making her most uncomfortable. Jump forward to about 3 weeks ago when Susan next went up to Dana Farber, and the decision was made to double the dosages for prednisone and tacrolimus. This has brought her back to higher levels than Dr. Soiffer would like, since the goal is to be gradually weaning her off this stuff, but it has also brought significant improvement in how she feels.
The current thinking is that as her body acclimates to all the changes in medication protocols she’s been through, she will be able to resume the path of medication reduction. The GVHD will, we hope, quiesce, even as the number and dosage levels of the drugs she takes are reduced. Do keep in mind that it is “chronic” GVHD, so she will continue to be subject to flareups. However, these generally diminish in frequency and severity as time passes (no guarantees, of course), and that’s why the Third Anniversary is a big deal.
One more thing: Part of Susan’s travails with the state of her mouth have to do, not with GVHD per se, but with the growth of a lesion called verruciform xanthoma. This is an uncommon, but not unheard of, fellow traveler with GVHD and is usually benign, though it can become quite uncomfortable. Dr. Treister (remember him, the guy who handles oral issues for transplant patients?) has decided to excise the lesion (and, of course, biopsy it) in an upcoming visit that Susan is working on scheduling.
More to follow when there’s more to say.
P.S. In case you haven’t figured it out (I know I wouldn’t have), the perhaps obscure 3.1.09 in this blog entry’s heading -- “Happy Anniversary 3.1.09” – indicates that it is 3 years, 1 month and 9 days after the June 2, 2009 transplant procedure.