On the War(Cam)path

So in case you haven't heard, I'm back in the hospital.

Before anyone freaks out, please know that I am not "sick," at least not in the traditional, infectious sense. I don't have a virus or a bacterial infection brewing in my lungs, no fever or strange symptoms, I'm not in pain or dealing with chills or nausea . . . at least not yet, anyway.

What I have right now is what most people want: an immune system that refuses to quit. Unfortunately, in a transplant patient, too much of an immune system is definitely too much of a good thing. And in my case in particular, it appears that we may be dealing with one (or both) of the following: recurrent acute rejection (recurring inflammation in the lung tissue and airways indicating an immune reaction, nonresponsive to traditional therapies like steroids) and chronic rejection (bronchiolitis obliterans syndrome, which is basically just persistent scarring and obstruction of the airways). Either way, the one thing that's clear is that my immune system and I have reached a standoff. It's been crampin' my style for awhile now, and there just ain't room in this body for the both of us.

So I'm officially evicting my t-cells from the premises, starting today.

T-cells are a subset of white blood cells that are part of the lymphocyte family. They fight infection by attacking intruders to the body, such as viruses, bacteria, or (in some cases) foreign organs. They are the border patrol of the metaphorical country of the human body. And mine have been misbehaving to an alarming degree, which we already knew. We've tried several methods to rein these guys in, but they just can't seem to help themselves. And just in case you think I'm kidding, here's a brief recap of the therapies we've tried thus far:

Increased steroids
Added immunosuppression drugs (aka, azithromyacin)
Antithymoglobulin Rabbit, or rATG (See this post: On Rabbits and Rejection)
Photophersis (See this post: This Little Light of Mine)

And now, please welcome to the stage (drumroll please) . . . Campath.

Campath is a brand name for the generic drug alemtuzumab, which is as crazy as it is unpronounceable. In very basic medical terms, it's an antibody infusion that targets t-cells and flags them for destruction by the body, leaving the person receiving the drug with little to no mechanism infection control. The good news is this can help stabilize and sometimes even improve declining lung function due to rejection. The bad news is, well, you lose your immune system. Like, entirely. For months or even years. Small price to pay for lungs that work, right?

To bring it back to the border patrol metaphor, using photopheresis for rejection is a little like starting a civil war to distract the patrol from attacking the friendly immigrants (like, say, a transplanted organ). Photopheresis changes some of your t-cells so that your t-cells don't recognize each other and therefore begin fighting amongst themselves. Kind of a dirty trick, but hey: all's fair in love and transplant.

Campath is more like a nuclear bomb -- instead of distracting the patrol, it just annihilates them and hopes that something else (aka, IV and oral antibiotics, antifungals, and antivirals) can pick up the slack to stop the bad immigrants like bacteria and viruses. It's generally considered a riskier option because -- like most bombs -- it can come with some added casualties and damage that no one really wants to deal with. In addition to leaving me ridiculously immunocompromised, for example, this drug can also increase the chance of things like skin cancer. Thankfully, regular visits to other docs like the dermatologist for preventative screening can help out with those additional risks.

Overall, I feel good about the plan, although I haven't actually received the drug yet. I agree with my doctor that right now we need to be aggressive in wiping out these pesky little patrolmen gone rogue, and as always I'm somewhat fascinated by the complexity of modern-day transplant care. I'm grateful that we have this option and so so hopeful that it will help my awesome Donor Bob feel a little more at home in his new(ish) surroundings. And trust me, between the option of keeping Bob around and keeping those rebellious t-cells alive and hopping, well, that's just a no brainer. I've enlisted some of the best doctors in the world to serve as generals in this crazy revolution, and I have every confidence that they will bring me through it with as little collateral damage as possible.

And that makes this a fight worth picking.