Day +1: Transplant complete

Sam's transplant happened yesterday on schedule, five months after his birth and three after his diagnosis. The donor cells arrived from San Diego early in the morning, and by 11:30 he began receiving the first of two 30ml transfusions. Sam's nearly always being infused with one thing or another (chemo, steroids, anti-fungal meds, anti-bacterial meds, meds to ward off graft-versus-host-disease, diuretics, hypertension meds, blood products of one type or another) so the transplant was, by appearances, sort of a non-event--just more stuff in a syringe being pumped into Sam's little body.

Mom, Dad, Sam, and 30ml of stem cells (in my left hand).

At about 3:30 the second empty syringe was removed, the catheter flushed with saline, and the procedure we'd been looking forward to with both hope and anxiety--a procedure that will either save Sam's life, or won't--was over.

Sam took it well--no fever or other adverse reactions. He then had a bath, his fourth wardrobe change (he may have the makings of a new immune system, but he still doesn't have any bowel control), and a snack. At about 6:30 we went home for the night, leaving Sam in the very capable hands of one of our favorite nurses.

Sam and Mom, transplant in progress.

Alyson and I then went out to dinner to celebrate the milestone and reflect back on how much has happened since June. Things have gone well, relatively speaking, and we're obviously hopeful that our good fortune will continue. There's not a lot to do now for the next few days, weeks, and months but fight off infection; hope the stem cells engraft and start to create a new, properly functioning immune system; hope for minimal graft-versus-host-disease; and, of course, wait to hear that the HLH is indeed gone, gone, gone from Sam's system--in other words, that he is cured.

This morning we received news that Sam had become slightly febrile and that the oxygen saturation in his blood had dropped enough to warrant a return of the dreaded (for Sam as well as anybody who's in the room and has to listen to the beeping monitor) oxygen cannula. Staff are not concerned--reactions like this are common after transplant. The fever's now gone, but Sam is still wearing the cannula. We hope it won't be there for long.

Sam's been a bit more subdued today, but he had some good smiley time and has yet to show any significant chemo-related side effects. The nurses occasionally have a Who has the cutest patient? contest. Sam is a repeat winner.