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t m c » p u l s e | j u ly 2 0 1 7 10 Blanca and Emil Romero at home with Sebastian, Kayla and Abraham. Martinez said it was the first time in her 10 years of transplanting SCID babies that she and her team weren't able to find a matched sibling or cord blood unit for transplant. Without many options left, Martinez decided on a different type of transplant, one that had never been performed on a SCID patient at Texas Children's: a haploidentical transplant. A haploidentical, or half-match, donor can be a patient's mother, father or sibling, as long as they haven't been exposed to certain viruses, including cytomegalovirus (CMV), a common virus that affects 85 percent of adults. Once a person is exposed to CMV, the virus remains dormant inside the body and can be reactivated. "Those viruses are like common colds, but when they reactivate in the transplant period … it can be a prob- lem," Martinez said. Fortunately, Romero tested negative for those viruses, making her an ideal haploidentical donor for Sebastian. Martinez administered a drug called granulocyte colony-stimulating factor to stimulate the production of Romero's stem cells and mobilize them out of the bone marrow to the peripheral blood for extraction. After measuring the amount of cells her body was produc- ing, Martinez and her team discovered that Romero had four to five times the amount of stem cells Sebastian needed for his transplant. Romero called them her "super cells." The extracted stem cells were then sent to a lab for graft engineering and T cell depletion, a purification process that separates unmatched T cells to pre- vent graft-versus-host disease (GVHD). Finally, on the evening of Thursday, May 25, Martinez and her team walked into Sebastian's hospital room carrying a small blood bag full of purified stem cells. They hooked up the bag to the IV pole next to Sebastian's bed and began administering 78 milliliters of the "super cells." Romero watched as the pink liquid snaked through the tube into Sebastian's central line. An hour and 10 minutes later, his body received the final drops of lifesaving stem cells. Homeward bound But Sebastian wasn't out of the woods yet. He was still experiencing side effects from chemotherapy. In preparation for the bone marrow transplant, Sebastian underwent 10 days of chemotherapy to suppress any remaining immune response that might reject the donor cells and to clear space in the bone marrow for the new stem cells to grow and expand. Although this is a necessary part of the treatment, it takes a painful toll on the body. "During the chemo days, he looked fine, but now to see the after effects, I can't do anything and nothing soothes him," Romero said. "I try to hold him and it's horrible. I can't do anything. It sucks. I wish I could just know what he's feeling." Monday, May 29, was one of their hardest days yet. Emil Romero sat in the pull-out bed, gently holding Sebastian in his arms, while the slack of catheter tubes attached to Sebastian's body trailed around them. Sitting next to her husband, Blanca Romero gazed for- lornly at her 3-month-old baby boy and listened to his subdued whimpering. "He has learned that, if he cries, it hurts him more, so he whimpers more than he cries," she said. "He doesn't babble as much either because it hurts him." As she caressed Sebastian's head, strands of his hair stuck to her hands, a side effect of chemo. Sebastian inched closer to her and started rubbing her face. Could he sense his mother's pain, or was he just practicing his hand- eye coordination? "There are moments when I'm pretty okay and then there are moments when I go into the bathroom and just cry it out," Romero said. "It's tough to Credit: Scott Dalton