Hi Deb, From my experience with several rounds of intense, inpatient chemo for AML, I did have some limited peripheral neuropathy with my hands and feet from the cytarabine and idarubicine. The worst of that diminished within weeks of the final session. I don’t recall having worsened neuropathy with the conditioning chemo for the transplant.

Chemo is notorious for causing PN. For most people it is a temporary issue. Here is a good article which will help clarify what happens: https://www.healthline.com/health/cancer/neuropathy-from-chemo

I believe @katgob, who recently had her transplant was given ice chips while she had her chemo to help avoid mouth sores. But I’m not sure that helps with avoiding neuropathy caused by chemo. I’ve read about the icepacks too. That will be a good question to ask of your transplant team.

Graft vs host disease can happen to any of us who have an allogenic transplant using donor cells. They are the graft which become our newly transplanted immune system. As was our old immune system, it will be in charge of safekeeping our body (the host). The only thing is, the body is now foreign and the new cells will seek to destroy it, just like it would any invader. Hence the name, Graft Vs Host Disease.

When the donor is selected, there are specific HLA proteins that are matched with our body so that there isn’t a huge disparity. Even so, there are proteins which won’t match perfectly. However, immune systems are adaptive, so even our new immune system, in time will learn to recognize these proteins and gradually the graft and host learn to play well together. Some take longer than others. In my case it was 2.5 years before I could fully stop taking the anti-inflammatory meds.

That’s why it’s important initially to be given anti-rejection meds (anti-inflammatory meds) to keep the new immune system from being too aggressive. It’s held back from its full potential for several months on the meds and then gradually you’re tapered off to see how the new immune system responds. There have also been breakthroughs in treatment since I had my transplant 5+ years ago with the meds that are preemptively administered at the time of transplant to prevent GVHD. They have reduced the potential for the disease.

If there is neuropathy caused by GVHD it would be handled differently than PN caused by chemo. While there can be some neurological issues, skin rash is generally the most common. Sometimes digestive system or lung issues. If a problem arises and is not treated quickly, then it can become chronic. Your team will check daily for any concerns you might have. That’s where it will be important for you to let them know if you see a rash on your body or have any new symptoms of a cough, diarrhea, or basically anything. I know that sounds nebulous but my nurses used to tease me that they wanted to know if I had a new hangnail. 🙃

Believe me, I had concerns of getting GVHD too. I think we all do! It sounded terrifying. However, my transplant doctor and team told me something that I found comforting, “You will most likely have some gvhd. You need some gvhd! We don’t know what will manifest or when, but we will take care of it…let us do the worrying for you.” And they did!! A burst of steroids (5 days) is usually enough to get things under control. We need to have some gvhd. It essentially becomes ‘graft vs leukemia’.

You and I have different forms of leukemia but both are caused by a glitch in our bone marrow (immune system). So replacing that immune system gives us a fresh start! That’s the goal; Getting a new, healthy replacement for our failing immune system…to prevent us from having the leukemia relapse.

My advice to you is not live in fear of gvhd and maybe stay away from the internet. Trust your transplant team instead. They become your family and have seen it all! They want a positive outcome for you as much as you do!
And you can trust those of us in Connect who have had our transplants. While completed at different clinics we have all experienced similar journeys along this path.
I hope you stay in contact along the way. I’m here for you along with all the other SCT members! I can’t remember, are you being treated as an inpatient, remaining in a hospital for an extended time or will you be an outpatient?