by Juraj Koska

Mid-July last year, Thomas stopped running because of back pain that he thought was
related to falling off a camping chair. Fast-forward, after several weeks of unsuccessful
physical therapy he found out that leukemia made it back into his bones. Two weeks
later he learned that it occupied also his liver and spleen. His plans of going back to
school and continuing his collegiate athlete career were put on hold. He had to go
through a lot of physical ailments caused by the leukemia itself or the many different
therapies tried to stop the disease, months of staying in the hospital room, and
uncertainties about the outcome. Some of the “fighters” he shared a battlefield with did
not survive their wars. Now, thank God, he is winning and is close to the end of the
tunnel.

The stomach biopsy at the end of April did not show any signs of graft versus host
disease. Day 100 bone marrow biopsy confirmed 100% of blood cells from the donor
with good representation of red blood cells, all types of white cells and platelets, and no
trace of leukemia. That was the green light for his doctors to wean off the
immunosuppression with Tacrolimus. It is needed to protect the host body from being
attacked by the immune cells from the donor. After each dose reduction the “unhinged”
immune system punched Thomas with loss of appetite and sick stomach. On those “dog days”,
Thomas was grinding through the meals in order to keep his weight stable.
Fortunately, these lasted only 2-3 days upon each Tacrolimus reduction, and eventually,
on June 27th , the Tacrolimus was discontinued. A fever on one night in early June
reminded us of what we were told back in March that he may be back on the hospital
floor with all these possible post-transplant issues. He did not make it up to the floor as
the fever was gone after 3 hours in the ER. It was probably caused by spiking
neutrophils in response to a neutrophile booster injection on the previous day.

Being off the immunosuppression also allowed Thomas to resume some activities. He
went on several late evening hikes and early morning golfing with his friends and
rejoined the church choir with weekly rehearsals and singing at Mass on Sundays. He is
not back to running as he is still struggling to put on weight. His new blood cells are still
multiplying to repopulate the bone marrow and other depots in the body and need a lot
of energy. Last week, on July 11th , they removed the central line that was coming out
of his chest and was used for infusing drugs or blood products and collecting blood
samples. They also discontinued two more drugs from the once long list which is down
to three now. Next week he will be allowed to jump in the pool. Later in July, he plans to
join his friend for a 3-day road trip to Utah and New Mexico. Upon return, he will start all
baby immunizations since his microbial memory is completely empty. Next on the
bucket list is a short trip to Colorado to do some fishing and day 180 bone marrow
biopsy that will provide a definite green light for heading back to Alabama. Bon
Voyage.