Memories of Max - A Father's Story

Chapter 10 - Transplant

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Max was going to have a transplant. Chemotherapy has its risks and worries, but transplant moves treatment to another plane.

A transplant involves the destruction of the remaining cancerous cells which also results in a destruction of the immune system. Most or all of the existing marrow is also destroyed in the process. This leaves the body defenceless to nearly all illnesses. The destroyed marrow is then replaced by either a previous extraction of the patient's marrow or the marrow from another donor. This donor may be a sibling or a completely foreign donor. Parents cannot be used as marrow donors because at best they only have a 50% match with their child and a 50% match is not close enough to prevent severe complications.

Marrow mismatch introduces the risk of Graft versus Host Disease (GVHD). If the replacement marrow does not originate from the patient then complications arise because the immune system of the foreign cells attacks the host body and vice versa. This can cause extreme difficulties as each set of cells tries to assert their immune response. We watched a child we knew well hanging by a thread for a week as she battled with GVHD. She survived and her parents put her survival down to the extraordinary dedication of the supervising doctor.

During a transplant the missing defences are provided by antibiotics and difficult nursing support procedures. These artificial defences are vital between the transplant and time at which the patient's body is capable of producing a normal immune response to everyday infections. It is a very intricate balancing act.

We were fortunately spared the worry of rejection because Max's transplant involved the re-introduction of his own marrow cells. Despite this, Max's transplant was still not trivial. At that time, there was still a one in twenty chance of the chemotherapy killing him.

We awaited the transplant treatment with trepidation. We were very frightened. We expected the effects of treatment used to try and eradicate the possible remainder of Max's cancer to be worse than any other chemotherapy that Max had received, even his experimental treatment. We were not let down.

The treatment started with hyper-hydration. This is a procedure where the body is flushed with water to prepare it for the chemotherapy. Max had a drip of seven litres of fluids in twelve hours. This is a huge quantity of fluid for a child. Max and I had a very sleepless night because he wet his bed ten times and I spent most of the night comforting him and replacing his sheets.

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