After a 3 ½ hour surgery, John’s spleen was successfully removed yesterday. The plan was to remove it laparoscopically but early on in surgery they realized it would be safer to perform an open splenectomy. It’s a much more complicated procedure with a longer recovery but it was necessary given the size of John’s spleen (it was larger than a 2 liter bottle of soda).
The pre-op preparations helped tremendously with surgical related bleeding (he was very high-risk for bleeding given his low platelet count – you may recall his spleen sequestered his cells). The day and night before surgery hematology tanked him up with a continuous platelet infusion, multiple bags of plasma and whole blood. During the surgery he did experience blood loss but the St. Jude blood bank was ready and waiting with blood products. All in all, he remained stable during the extensive surgery and the surgeon & anesthesiologist were pleased.
The spleen will be sent off to pathology and within a couple days we should hear if they find anything unusual – outside of the millions of cells it’s been sequestering! Damn spleen!
John can live without a spleen but, because the spleen plays a crucial role in the body's ability to fight off bacteria, living without the organ makes him more likely to develop dangerous infections. He will be on indefinite daily antibiotics and will, depending on his immune status, receive vaccinations protecting him from pneumonia, meningitis, and other serious infections.
John spent last night in the ICU - happy to report we are back on the Transplant floor. The new ICU at STJ is amazing but we were ready to get back to the comforts of Room 9. John is on a Dilaudid pain pump, giving him some relief from the 23cm long incision. He sat up this morning in a chair and chatted briefly with us about the surgery. He’s back in bed, resting, somewhat comfortably.
Monday’s MRD came back at 0.012% - down from last’s weeks 0.035% and the previous week’s 0.089%. He did receive a small dose of chemotherapy two weeks ago but the “team” is considering the possibility that his new cells may also be fighting his leukemia. Rich and I know that it is VERY unlikely that a late engraftment can fight off any or all of his residual leukemia but we are going to pray that John’s body will have a robust recovery and his new donor cells will finally, sans the spleen, have chance to show what they can do!
ReIntensification is on hold for one week. We’ll check his MRD next Monday: if it’s 0.012% or less he will receive another NK cell infusion using my cells, if it’s 0.012% or greater we’ll most likely proceed with chemotherapy as planned.
Rich and I know we need a miracle for this “best case scenario” but we are still praying for it! Please pray John’s body continues to engraft and his immune system strengthens – fighting off all remaining leukemia!