You ask a very good question, I am not sure I have a very good answer for you - I am making an educated guess here.

For starters, your husband had an adult donor and therefore a high nucleated cell dose (therefore high dose of stem cell). Cord blood transplants, even when they use double cords, have much smaller number of stem cells in them. This means there is higher degree of mixed hematopoiesis (auto and allo) for longer periods with cord blood transplants.

I understand that the ratio of graft and host armies in the bone marrow and peripheral blood can be different in the early days after a transplant, hence the need for doing chimerism testing on both blood and bone marrow aspirate.

It is also my understanding that risk of graft failure (where the graft is killed off by host T-cells, either left over because the mini-allo conditioning was too kind and gentle, or because the host T-cells had a chance to reconstitute before the graft had time to set up shop and produce its own defences) is higher in cord blood transplants.

Off-setting these disadvantages for cord blood transplants is the ability to find matches for many more patients, as well as significantly reduced morbidity due to GVHD.

Bottom line, while adult donor and cord blood transplants have a lot in common, they are also different in some important ways.

Hope this helped answer (partially) your question.

Chaya

I am glad someone besides me noticed the peculiar little flat area from D+9 to D+11 in the WBC trend, followed by renewed trend upwards.

There is an interesting theory to explain this, but I have no way of proving it one way or the other.

Initially, right after Day Zero, neither of the two new cords is yet engrafted and therefore doing precious little by way of white cell production. As for the host immune system, it too is flat on its back, knocked out cold by the prior chemotherapy and radiation. WBC languishes at a rock bottom 0.1 for a while, up to day +5 in Harvey’s case.

After this, for a while, there is contribution to white blood cell production from the host as well as the grafts, a mixture of (host)autografting and (cord) allografting. In Harvey’s case this appears to have been the case from Day +6 through Day +9. I expect gradually the contribution of the allograft becomes more pronounced over this period.

Past Day +9 the grafted immune system is strong enough and the host’s original immune system is weak enough that the former kills off the latter. The flat portion from Day +9 to Day +11 represents the allograft white blood cell production making up for a rapid fall off of any production from the original host immune system, managing to hold the line in white blood counts in spite of it.

Past Day +11 the graft (or grafts) are now in business and accelerating their production of white blood cells at a fair clip and the curve trends up again. As of today, Day +14, the WBC is a healthy 1.5K.

Red blood cell and platelet production will not start for at least another couple of weeks. Since Harvey’s RBC, hemoglobin and platelet counts are now flirting with the transfusion trigger points, I expect he will be receiving these blood products until the graft starts doing its job in this area as well.

This is the theory suggested to me by one of the staff here and it makes sense to me.

Chaya

It’s quite lovely to see the monotonic increase in WBC. The flatness from D+9 to D+11 is curious…any correlation to Harvey’s FUO?

I will soon be finishing up my first course in the Masters program, Integrative Health and Wellness, from U of N.J. Who knows maybe someday I can make a contribution to CLL Topics on the latest in Integrative management of CLL!

Terry is doing great…no rebound of the cancer and al his other cell counts are fabulous six monthhs out post R-Chop. His FISH shows 100 male chromosome 46XY..not enough of anything else to count.

We wish you the best in your journey towards ever more vibrant health! Thank you for all you give!

Nancy Moran