Graft Failure Enough to Give You Nightmares

Normally, if I have a nightmare about blood cancer, it’s about relapsing. I assume I am not alone. It’s a big fear, and so it makes sense that it seeps into our dreams.

The other night, though, I had a nightmare about graft failure. It was traumatic when it actually happened after my second stem cell transplant, back in 2008, so I’m surprised it hasn’t infiltrated my dreams more since then.

Before I get to the nightmare, I’ll explain what happened in 2008, and what graft failure is.

My experience with graft failure

It was six months after my second stem cell transplant — my first allogenic — when a friend drove me to the Dana-Farber Cancer Institute on a day when I felt very sick. I had a fever and flu-like symptoms.

My nurse practitioner said they couldn’t let me go home. I was admitted into Brigham and Women’s Hospital, into a dark room, looking out at a wall that mirrored my mood. My doctor came in and said there was good news and bad news. The good news was that I hadn’t relapsed. That was a relief. The bad news was that my bone marrow was basically empty. The donor had packed his bags and left.

It was secondary graft failure - “loss of donor cells after initial engraftment.”¹

In an article on the topic, medical researcher Dr. Robert Peter Gale wrote, “Persons failing to recover normal bone marrow function after a transplant are sometimes referred to as having primary graft-failure, whereas persons with initial recovery of bone marrow function followed by deterioration or loss of bone marrow function are referred to as having secondary graft-failure.” He called it “an even bigger mess” than an initial failure to engraft. Complications include bacterial and viral infections. No wonder I felt so bad.²

I got an infusion of donor T-cells, but this did not help. A dose of intravenous gamma-globulin therapy did help me fight off the infections. It worked well enough for me to be sent back home to rebuild my strength. I would need it because next up was chemotherapy again before I could get another transplant. You can imagine that I was not happy. My hair was just coming back. They said it would not be as intense as the time before, but they had to do give me chemo to prepare me for my third transplant.

My doctor theorized that the graft failure was a fluke. The donor seemed to be a good match, and he agreed to donate again.

My graft failure nightmare

In my dream, a nurse inserted a needle in my arm to draw blood. But nothing came out. I said I wondered if it was a bad draw and asked her to try it again. She did it again, and the syringe was empty. I had a sinking feeling.

The fodder for the nightmare seems to be both graft failure and extracorporeal photopheresis (ECP), a procedure that I get to stem the effects of graft-versus-host disease of the skin. It involves having a needle inserted into each arm. One is the draw, taking out blood to be treated, and the other is the return. If indeed as in the nightmare, nothing came out of the needle, that would be bad. I was glad to wake up.

A waking nightmare happened about six months after that third transplant. I relapsed for the second time. I went through the process AGAIN and this time got a new donor. That was 11 years ago. All things considered, despite neuropathy and graft-versus-host disease of the skin, I am doing well. I managed to run six miles the other day, after all.