Thud!

That's the sound of Keri and me falling back to earth. We learned yesterday that despite a promising beginning, the transplant team has been unable to find a good HLA-matched donor for Mina Brigitta. They still have three more donors to type, but are not optimistic that any of them will work out. However, they were able to identify three possible matches from donated umbilical cord blood, one of which they know is a reasonable 4/6 match that they would be able to use for transplant. The other options are to use either Keri's or my stem cells, or conducting a more detailed search of the European registry. The latter would take several weeks, probably necessitating another round of chemo to make sure Mina Brigitta stays in remission.

The problem with using less-closely-matched stem cells is the increased likelihood of side effects from graft-vs-host disease, where the new immune system (the "graft") attacks the host's body. Cord blood does seem to cause fewer problems with graft-vs-host disease, possibly because the donor has not yet experienced immune response. However, it is also less likely to engraft (i.e., be successful at taking over her bone marrow), and if they have any problems they can't go back and get more. A 6/6 adult donor match would have been preferable, but apparently was not in the cards. Our road just got steeper again.

The other thing I learned yesterday (I guess Keri already knew this) is that sterility is not just a theoretical side effect of the conditioning regimen, but an almost certain outcome. I just hate that thought, especially since our girl is such a mother to her dolls, and her brother.