Thursday, April 04, 2013

Blood Stem Cell Transplants in the 21st Century

When I first heard about bone marrow transplants, I envisioned the donor getting drilled in the hips for bone marrow extraction (like the bone marrow biopsy and aspiration) and then a surgeon drilling into my large bones to implant the donor marrow. I am happy to say that I was way wrong!

In most cases, blood stem cells are harvested from the donor through a process called Apheresis. It is like donating plasma (some of you may remember college students doing this for weekend money).   

Over the years, the stem cells that get transplanted have many names:  
bone marrow, stem cells, hematopoietic stem cells, peripheral blood stem cells, and pluripotent stem cells. These are the stem cells that become red blood cells, white blood cells, and platelets. 

What's Involved in the Transplant Process

For me:    Patient and her caregiver must live near the transplant center for 6 months.
The week leading up to the transplant, I get blasted with chemo that will kill all the cells in my bone marrow (among other things) and also receive immune-suppressants to prevent my body from rejecting the stem cells.  I’ll lose my hair, get mouth sores, feel like crap…

For my donor: The week leading up to the transplant, my donor will have labs updated (to ensure no new infections) and get a growth hormone shot each day for 5 days.  Then will have blood drawn out of one arm; the stem cells are separated in a bag for me, and the blood is returned to the donor in the other arm.  Generally takes 4-6 hours. S/he will likely feel fatigued for the next couple of days. 

For me: I will receive the donor’s stem cells by IV.  Then I sit and wait for those brave stem cells to engraft in my bones and begin producing blood (takes 2-3 weeks).
I’ll also continue to receive anti-rejection medications for the first 6 months post-transplant.

At day 100: a bone marrow biopsy will be done to see if the transplant is successful.

Major Risks of SCT

Transplants for secondary Myelofibrosis are very different than transplants for other leukemias and much more intense than organ transplants.

The risks are highest in the first year of transplant.
1. Risk of Graft Vs. Host Disease: 30-50% with sibling donor.  Of those 20% will not be responsive to steroids (aka steroid refactory).  MF patients have more GVHD than other leukemia patients.
2. Risk of Death: 15-20% within the first year.  Organ failure is most common cause.
3. Relapse Rate: 20% within the first 1-3 years
4. Graft vs. MF effect:  treated with donor lymphocyte transfusions

These are odds I'm confident I'll beat.

1 comment:

Alice Ramsey said...

your positive attitude is a major factor in your success, so I'm adding mine and my prayers that you beat those odds. love you!