Cyclo

John is on an immuno suppresant called cyclosporan.  After every Allo transplant the patient goes on cyclo or tachro to suppress the immune system.  The reason this has to be done is basically to try and keep the GVH from flaring too bad.  These drugs go right to the T cells and try to stop them from dividing and suppling an immune system. It T cells divide too fast the body can be surprised by the new T cells and cause major GVH. After John's transplant he was on tachro.  Tachro was taken twice a day and should pretty much clear the system every 12 hours.  When John was admitted 9 days after being released from his Allo, his tachro level was at 29.  At that point he had not had it in almost 2 days (he had been throwing it up). So, his level should have been 0.  Tachro clears through the liver and John's liver was not functioning normal and was not clearing the tachro. It took 15 more days for his body to clear that tacro.  Some days it did not go down at all.  Because he had GVH he also went on the steroids (prednisone). Prednisone basically does the same thing as tachro and cyclo, but it clears through the kidneys and has way worse side effects.  But it was necessary to fight the GVH for John. Leaving the hospital they started John on cyclo (instead of tachro - basically a cousin drug).  They have been watching his labs twice a week and monitoring his levels.

Their first goal was to get John to a cyclo level of 100.  It took 6 weeks of adding very slowly and watching his labs to finally get him to 100. (Which was just this week). We found out yesterday that a level 100 won't do a whole lot of what cyclo should do and most patients need to be around 300.  But, because John has been on a high dose of steroids, no one was worried.  But, now more balancing between these 2 drugs.  The prednisone is being tapered at 10 mg every 5 days. (He left the hospital taking 180 mg a day). He is now taking 110 a day. Once he gets to 80 in about 11 days, they will keep him at that level, probably for a few weeks and then taper more.  During this time, his cyclo level will slowly be increased.  He has to have this immuno suppresant for at least 1 year before the body can try to work better with the new cells.

John is only one week away from his day 100 post transplant mark!! The thing is, that typically at day 100, the tachro/cyclo starts to taper. But, John has not even gotten close to the 300 mark to start to taper. Typically it is a 9 month taper. So, it will have been one year of the immuno suppresant.  Looks like John's will be a bit longer.  It may take a few more months to even get him to 300, then keep him there for a few months, then taper for 9 months.

The Dr's on East 8 are SO good at doing what is best for every patient.  They truly care and watch every patient. Every day in rounds talk about every in patient and once a week talk about out patients.  John has been so far off of protocol, but that doesn't matter. He has been different from the moment he walked in those hospital doors on October 16, 2012.  They literally had to research his type of cancer and call specialists to see what to do. And they have been amazing!  So, for now - we hold on to faith and keep trusting these amazing Dr's. And watch his body and see what it can handle.