Recipe for a Stem Cell Transplant

Executive Summary:
Take some blood out, collect some pre-cancerous stem cells from it, and put the blood back in. Then kill the cancer by killing everything in the bone marrow - good cells, cancer cells, innocent bystander cells, etc.  Put the harvested stem cells back in and hope everything starts working again.

More Details and a General Schedule:

First Week (Phase 1 is the first two weeks):
The first 1 to 3 days will be various tests to determine the current stage of the myeloma. For the record, it had increased significantly in October, and then began to skyrocket when tested at Mayo in Novmeber.  It will be during this time that my bone marrow will be sampled and analyzed.  Stem cells and blood cells are produced in the bone marrow.

For the next four days, I will be given shots to stimulate growth of stem cells, which might include an extra "kicker" shot on the last day.

Second Week:
One the first day, as assessment will be made of the stem cells, by collecting a blood sample. If ready, collection of stem cells will begin the following day by a process called plasmaphereis.  It will not be necessary to go into the bone marrow to collect the stem cells. Although produced in the marrow, they become dislodged and float through the blood. It is believed that the stem cells are pre-cancerous, and it is not until they develop into the protien cells that they become cancerous.

Anyway, for the plasmapheresis I will be hooked up to a plasmapheresing machine for about 4 hours each day of this stage. Blood will be withdrawn from my body, spun in a centrifuge to seperate the pre-cancer stem cells, and then the rest of the blood will be replaced back into my body.  It usually takes 2-3 days to collect enough stem cells, but can take up to six.  The amount of stem cells they collect depends on a person's age and weight, and they plan to collect enough stem cells to do two transplants.

Weeks 3 & 4 (Phase 2):
The first two days are when the actual chemotherapy takes place. I will be given high doses of melphalan. This will kill the cancer cells and everything else in the bone marrow. In the analogy of a garden filled with weeds, kill everything in the garden, weeds and good plants, too, and we'll come back in later and re-seed with the good plants. During these two days, I will have extreme nausea.

On the third day, they will start re-seeding with my stem cells to get my bone marrow going again. Pretty scary stuff, but it seems to work. Begining on day 4, the chemo starts to catch up with me, and I will spend the next 1-2 weeks feeling really crummy, losing my hair, and have the cells lining my throat, esophogus and stomach damaged.

Recovery:
Should take about another week, for a total of 5 weeks, if all goes well. It could easiley go another week or two. They send me home when I am done.

The whole thing will be done on an outpatient basis, and we will likely be staying in a group home called th Gift of Life Transplant House.

What's Up?

Many of you have been kind enough to ask for prompt information as to what happens with us up here at Mayo. We met with the blood cancer doc today, and it was decided that we will proceed with a stem cell transplant here in early 2013. It will require us coming back up here for several weeks at that time. It will be an arduous and unpleaseant process, but the end goal will be having the cancer go into "durable remission," and stay off of chemo for 7 to 10 years when it's done.  That's longer than the initial period given for anticipated survival at the time of diagnosis 5+ years ago.

Thanks to all for your many prayers in regard to this visit! We'll keep you updated as things get scheduled and further information develop in the next few weeks.