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Drew Spinelli Round Two
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Round Two

Less than one month after Drew completed his Bachelor’s degree at Saint Joseph’s University and was preparing to start a wonderful training program for the United States Department of Defense, he was hit by another primary cancer. This time it is leukemia.  But, as before, Drew took the news like the hero he is and got prepared to fight another nasty battle with faith and courage. He started chemo treatments at Pennsylvania Hospital under the care of the wonderful oncologist who was so helpful in Round One and the very special nurses in the Cancer Center who have all become our dear friends. He was making progress and went into remission and was preparing for a bone marrow transplant. His older brother, Eric, is a perfect  match for Drew.  Unfortunately, the results of the last of his bone marrow biopsies were not good - the dreaded leukemia spiked again and the battle was destined to continue – even more aggressively. The transplant has to be postponed until the leukemia is in remission ideally - but, at least, at a lower level.

He was transferred to the Hospital of the University of Pennsylvania where he has received numerous very stong, high dose chemotherapies. Unfortunately, none have been productive in ameliorating this very, very aggressive form of leukemia. He has dealt with so many nasty chemo side-effects, nausea, fevers, very painful mouth sores that lined his mouth and down his throat and almost blocked his air passage (he couldn't eat or even open his mouth for several weeks), major swelling, headaches, skin rashes, etc.  The very frustrating thing was that these chemos with their hateful reprecussions - didn't result in the goal of remission.  Since Drew obviously will not be in remission when he goes to transplant - which was the goal- we have to settle for going to transplant with the fewest leukemic blasts as possible. Unfortunately, the week before the planned transplant, Drew's white count when up again to a dangerously high level - which puts the transplant at great risk. Dr. Porter, our hematologist and the transplant specialist, is aggressively trying a series of drugs to lower Drew's white count enough for the transplant. Please see latest updates. 

Drew is heroically fighting in Round Two.  We are so grateful that his family, friends and all his supporters are rallying around him with incredible support and earnest prayers for his full recovery. 

Plan for the Transplant -  Drew will be admitted back into the Hospital of the University of Pennsylvania on Sunday, July 22nd to be start his preparation for the transplant. In the meantime, there is alot going on in preparation. Drew continues to get treatment to reduce his leukemic cells, while doing all he can to build up his strength, his stamina, and his spirits. He's doing an amazing job at all of this.

At the same time, Eric is preparing to donate his stem cells on Thursday. On Sunday he began taking injections of a drug called Neupogen, which will boost his stem cells so that there will be plenty to collect for Drew. This can be a somewhat uncomfortable process, but Eric isn't complaining! He knows how important his job is! Then, on Thursday, he will go to the out-patient clinic at HUP and the stem cells will be collected through a process called apheresis. This process allows the medical team to draw stem cells from Eric's body through an IV. The blood is then processed through a machine that separates the stem cells, which will go to Drew, and the rest of the blood, which will go back into Eric through the IV line. Most likely, this will be done in a day, although occasionally a second day of collection is necessary. The goal is to collect several million cells. It's amazing how many fit into one small bag! These will then be saved to be given to Drew next week. At this point, Eric will have completed his job as the donor and can go back to being big brother. 

 Drew will be admitted to the hospital on Sunday and will undergo a surgical procedure to have a Hickman catheter inserted. This is a central line placed in his chest that has several lumens, or little tubes, which allow for several interventions to be done at the same time. He already has a port (another central line) in his arm, but the additional access will allow for multiple tasks, such as the administration of chemo and the other drugs, fluids, and TPN (intravenious nutrition) to be done at once.  

On Monday and Tuesday  (July 23rd and 24th), Drew will get very strong chemotherapy and on Wednesday, Thursday and Friday (July 25th, 26th, 27th) he will receive full body irradiation. The goal of these treatments is to destroy all remaining leukemic cells but, in the process, it will also completely destroy all his white cells and all of his bone marrow. In short, it destroys his immune system to allow Eric's to come in and take over. This is one of the main dangers because it means that Drew will have no protection from any bacteria or viruses, or any germs we come in contact with on a daily basis.

On Friday evening, July 27th, Drew will receive Eric's donated cells through his Hickman catheter. This is not a surgical procedure and does not require Drew to go to the OR. It takes place in Drew's hospital room. The bags of cells, which have been frozen since they were collected from Eric, are thawed out in warm water and and drawn up in a syringe. The cells are then infused into Drew through his Hickman catheter.  It usually takes less than an hour, often only a few minutes, to complete.

The transplant itself is rather anti-climactic. What most people notice most is the odd taste in their mouths. This comes from the preservative used to freeze Eric's cell until they are transplanted. The description of the taste ranges from garlic to creamed corn to strawberries! Can't wait to hear what Drew thinks! The preservative also has an odor, which visitors are likely to notice. Many people say it smells like garlic, but those of us who love garlic are likely to disagree.   

Once the transplant is done, the waiting game begins. Within about ten days of transplant we are likely to see cells begin to return to Drew's bone marrow and blood stream. In the interim he will require transfusions of  red cells (which provide oxygen/energy) and platelets (which protect from bleeding). White blood cells (which fight infection) cannot be effectively transfused, so Drew will need to be protected from infection in other ways, such as handwashing, special diet, gloves and gowns, etc. Most important, of course, is that he not be exposed to anyone who is ill. As much as everyone's support is valued, no one should visit who is sick or may be getting sick.

During the time Drew is in the hospital he will probably have days when he feels OK and days when he feels lousy. It's probably a good idea to call before visiting, to be sure he's up for company. Despite all infection control efforts, he is likely to get an infection and there will be antibiotics to treat it. There will be a number of other effects of treatment for which he also will be closely monitored and treated. Drew is likely to be in the hospital for four to six weeks, maybe more or less, depending on what side effects/issues arise.

 The goal is to completely eliminate all Drew's cells and for Eric's healthy cells to take over. However, process takes time and often has many ups and downs. It will not be over when he comes home from the hospital. Even after that he will be at high risk for  infections so certain precautions will continue.

 Following the transplant, Drew will also be at risk for graft-versus-host disease. Most of us are familiar with the idea of rejection after many kinds of transplants. This is basically when the patient's body rejects the foreign cells of the donor. Graft-versus-host (GVHD) is really the opposite of that: it is when the donor's cells see the patient's cells as foreign and attack them. This can result in a number of problems that can range from relatively mild to very serious. Typically, GVHD affects the skin, the gi tract, the liver, or the lung. It can also cause dry eyes and dry mouth.

Drew will return to the clinic very frequently so the medical team can monitor and/or treat any signs of infection or GVHD. He will be taking MANY medications, including immunosuppressant drugs that will try to limit the effects of GVHD. It is often said, however, that "a little GVHD is a good thing" because, just as it can attack other parts of the body, it can attack the leukemia cells. Over time, the doctors will start to taper the immunosuppressant drugs, hoping that both the GVHD and the leukemia can be kept away. There can, however, be ups and downs in this process, times when the medications are tapered only to find an increase in GVHD symptoms, so some of the immunosuppressant medications are increased again. Sometimes, although we hope not, the leukemic cells can start to reappear, and the immunosuppressant medications may be reduced to allow the GVHD to fight the leukemia. Clearly, we hope that none of these challenges occur, but they are not uncommon with this kind of transplant, and there are many ways to address them if they do.

 Dr. Porter and his team have repeatedly told Drew that a bone-marrow transplant is the most dangerous procedure known to man.  Drew is very aware and knows that bone marrow transplant is a must for him. Fortunately, he is young, strong, and determined. And he has loads of love and support to help him through!

 

Kyle David Group DrewSpinelli.com