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September 17, 2006 , Day 38


I wanted to explain the transplant process to everyone, in case people might not understand what is going on. Stem Cells have been in the news a lot recently, too, so there may be some confusion about what is going on. The controversial stem cells are embroyonic stem cells. I won't be getting any of those, just adult stem cells from Bob.

The stem cells I am interested in are located in the bone marrow. In adults, the bone marrow is pretty limited to the hip bones and the sternum, as I understand it. The bone marrow has a structure that is similar to a tree. Lots of branches. In order to nourish the bone marrow, blood flows through the branches. Imagine, if you will that each of the branches of the bone marrow has a "birds nest" on it, and the stem cells sit securely in the "nests". Normally, the stem cells create new blood cells, but they can also produce new stem cells if they are required. If there are empty nests, these new stem cells will fill up the empty nests until they are all full.

Right now, Bob is getting shots that stimulate stem cell production. Once all the "nests" in his marrow are full, additional stem cells are released into the blood stream, because there is nowhere else for them to go. Tomorrow (Monday), they are going to start collecting these stem cells from Bob's blood. Because I need a lot of stem cells for my transplant, they will probably collect cells from Bob on Tuesday also.

The transplant has several phases. The first phase is the conditioning regimen. Seems like kind of an odd name to me, but this is a week of chemotherapy that is designed to kill off all the stem cells in my body. All of the nests are empty when the conditioning regimen is complete. I will be an inpatient in the hospital for this chemotherapy, since there is danger of infection and need for tansfusions to keep me alive. After the chemotherapy is complete, they will start the second phase that consists of giving me the transplant. The transplant is pretty anticlimatic. It is basically a transfusion consisting of the stem cells that were collected from my brother. It will probably take about 30 minutes. It is completely painless. These stem cells will be circulating in my blood. The next phase of the transplant is engrafting of the stem cells. As the stem cells circulate through my bone marrow, and they run across the empty nests, they will fill the nests and stay there. Once they get comfortable in the nests, hopefully they will start producing new blood cells. When we start seeing new blood cells after the transplant, we know that the transplant was a success. This is where the real problems start. The issue is that these new blood cells are my brothers cells, not mine.

Because white blood cells create an immune response, my brothers blood cells could reject my body and start attacking it. This is known as Graft vs Host Disease, or GVHD. To combat that, I will be given a cocktail of drugs to suppress my immune system until Bob and I learn to get along. It is quite possible that this may be a lot easier for me this time, since this is my second transplant from Bob. It would be great if I didn't have to be immunosuppressed for a long time. The big danger of the transplant is from GVHD and from infections. If I don't get GVHD and don't need to be immunosuppressed, I probably won't get real bad infections. This may just be wishful thinking on my part, but I hope it works out that way.

I will probably be in the hospital until my blood counts start returning to normal, similar to what happened after my induction chemo. The big differences will be that it should take a lot less time, and that I will still be immunosuppressed when I get out of the hospital. I will have to avoid sources of infection, like people, dirt, birds, fountains, the ocean, uncooked food, spinach :-) and other things. The immunosuppressants will be gradually eliminated from my system as long as I don't get GVHD. As they are eliminated, my immune system will start protecting me more and more. For my last transplant, it took about a year to get rid of all the immunosuppressants. I hope it will be quicker this time.

Well, that is a snapshot of what the transplant is all about.

I don't have lab results from yesterday, but they probably are not too exciting. I will get the lab results tomorrow when I am at the hospital for a checkup. I will send out an update tomorrow!

Lab Results

Blood Cell Type

Normal Low





WBC 4.5 8.5 7.7 8.9 nr
RBC 4.3 3.29 3.18 3.45 nr
HGB 13.9 10.8 10.2 10.9 nr
PLT 130 83 110 179 nr

Hope you all had a great weekend!

Menchie and Ted

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