What is a Stem Cell Transplant?

While I have mentioned numerous times in my posts that I have had two Stem Cell Transplants, I realized there are a lot of people who don’t really know what they are.  So I will give you my version of what they are and how they work, but please do not take this as gospel.  Talk with your doctor about the details.

The American Cancer Society has a very good description of Stem Cell Transplants at: https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/stem-cell-transplant.html

WebMD also has good descriptions: https://www.webmd.com/cancer/features/stem-cell-transplant-types#1

While your body has all kinds of stem cells which contain the directions on how to create the organs in your body, I will be talking specifically about the stem cells that create the blood-making system in your bone marrow.  These stem cells are present in everyone’s blood stream.

When a person is diagnosed with Multiple Myeloma, this is actually a cancer of the bone marrow.  The bone marrow is the spongy material in the center of all your bones.  In this material are the cells that create your red blood cells (which carry oxygen throughout your body), your while blood cell (which serve as your disease-fighting immune system) and your platelets (which enables you to have blood clotting capabilities).  When these cells are created they are excreted through your bones and into your blood stream.  With Myeloma the cancer cells multiply in your bone marrow and crowd out the blood-creating cells.

As I have detailed in some of my earlier posts, there are a lot of different drugs and treatments both on hand and “in the pipeline” that are aimed at killing off the Myeloma cancer cells in the bone marrow.  In many cases, doctors recommend an Autologous (“Auto”) Stem Cell Transplant.

In these kinds of transplants, your doctor will initially give you different drugs and treatments, all of which are aimed at reducing the level of Multiple Myeloma in your bone marrow to as low as possible.  Many times they can’t completely eliminate the cancer, but the lower they can get it, the better.  These treatments can last anywhere from one month to several months.

Eventually they will get the cancer presence as low as possible, and then they will move into the transplant.  First they will give you a shot each day for a few days that will stimulate your body’s creation of your stem cells circulating in your blood stream.  Next they will go through the process of “harvesting” these stem cells from you.  This is a relatively painless process where they draw blood from one of your arms, send it through a machine that separates out the stem cells and puts them in a bag, and then returns your blood back into you in your other arm.  They have different things that impact how many of your stem cells they need to collect – your body size and if they are going to save a batch for a possible future second transplant.

Once they have collected your stem cells, it is time for the big guns.  Here is where they will give you a very serious and toxic mix of chemo drugs.  These drugs are intended to kill off all of your bone marrow throughout your body.  This is not fun you will likely get pretty sick during this part of the process.

After a few days and they determine the drugs have done their job and killed off all of your “old” and diseased bone marrow, they will infuse your stem cells back into your body.  Since they have killed off all of your old bone marrow, this infusion day is typically called Day 0 (sometimes referred to as your new birthday.)  Your stem cells will then migrate into your bone marrow and start setting up a new, “clean” shop where they will start creating all new, and hopefully disease-free blood cells.

Over the course of the next few weeks you will need to be monitored very closely.  First off, without any white blood cells you don’t have an immune system, so it is very easy to get sick and it can quickly develop into something very serious.  You will also be checked every day on the progress of your new blood creating system and if you need to have red blood cells or palettes infused, a boost given to your white blood cells, and/or an infusion of any of the many chemicals your body needs to survive.

Hopefully after a month or so, your new blood creating-system will be up and running in your bone marrow and spitting out disease-free blood cells.  But it will still take another month or two before you start to feel “normal” again.  As I described in an earlier post, going into the transplant in as good a shape as possible and then pushing yourself to start walking every day will be a great help in your recovery.

Sometimes doctors recommend a second, or tandem, transplant where you go through the entire routine again.  There are a lot of different opinions out there about this, so be sure to check around so you can make an informed decision.

In the case of my Acute Myeloid Leukemia, that was a cancer primarily of the white blood cells.  The “typical” treatment also includes a stem cell transplant, but this time using the stem cells from a matched donor.  This is where having several brothers and sisters comes in handy, since they are the most likely to be a match to you.  Otherwise you will need to check on your children and/or the National Bone Marrow Registry:  https://bethematch.org/

Once a matched donor is identified, the process is similar to the Auto Stem Cell Transplant, except the stem cells are harvested from the donor.  The big difference is the fact that your body’s natural reaction is to reject a new organ put into your body.  So you will be given countless drugs to hopefully mitigate and control this rejection process.  As a result, this kind of transplant is much, much tougher on your body.  I was told that I had about a 50/50 chance of surviving the first six months of the process.  That really hit me – basically the odds of a coin toss!

But this is when you need to pull yourself up and determine that you will be in the positive fifty percent!  It will be a long, hard fight, but you can do it.  I was told it typically takes a year and a half to two years before you get back to your pre-transplant baseline, and I have found this to be pretty accurate.  But just focus on one day of recovery at a time and before you know it, you will be there!