Stem Cell Transplant

I wrapped up my 5th cycle of induction chemo this week. Just one more to go until we get to the Stem Cell Transplant.

As I pointed out in my treatment plan post, the Stem Cell Transplant (SCT) is the second part of this journey. Before describing how it works, I’ll explain why we do it.

The SCT is a means of administering a heavy dose of chemotherapy.. That’s it! It’s basically enough to kill off a large farm animal. It should kill any cancer remaining in my system and set me up for a long remission. (aided by maintenance chemo, part 3 of my treatment plan) I’ll go on to explain how it works. If you want more detail, Nick Van Dyk has a great post that explains it well.

There are basically two forms of Stem Cell Transplant pertaining to Multiple Myeloma treatment. Autologous (where the donor is also the recipient), and Allogenic (where the recipient gets stem cells from someone else — and thus gets the donor’s immune system).

Allogenic transplants are risky but also offer a higher chance of reward. Even with a perfect match, there is still a chance of rejection which could be fatal. Depending on who’s statistics you believe, an Allo transplant would run up 20% risk of death, 30% chance of cure, and 50% chance of something in between. The perfect scenario for an Allogenic transplant would be for the donor to be your identical twin (without Multiple Myeloma). Sadly, I don’t have an identical twin.

Given the dangers of Allogenic transplants, they are typically only used in high-risk situations. Autologous transplants are the “standard of care” in treating standard-risk Myeloma, which is what I have. Autologous transplants also have a sub-1% fatality rate, so they are much safer to administer.

My Stem Cell Transplant will look something like this:

In late May, after I finish my last induction chemo cycle, we will harvest my stem cells. That involves giving me shots to stimulate production of stem cells, and they’ll hook me up to a machine for up to 8 hours a day for 2–4 days until we harvest enough of my stem cells for 2–3 transplants. They’ll then freeze and store the stem cells.

After a few days of rest, I will check into the hospital and get the chemo. The drug in question is called Melphalan, and it’s really nasty stuff. It’s a cousin of mustard gas, and it works by damaging the DNA of rapidly dividing cells to the point where they die off. In addition to killing off the Myeloma, it will also get my hair, my gut bacteria, my bone marrow, and some other things.. If they did nothing after this step, I’d die in a few days because I’d stop producing blood.

The next day after the Melphalan, I get my stem cells back. While the Melphalan is busy killing away, the stem cells go to work rebuilding stuff. My white blood count will go to zero at some point in the first week or so, and I’ll have a few awful days where I can’t really do anything. Then finally my stem cells will start building bone marrow and I’ll produce my own blood again. Most people get out of the hospital at around the 3 week mark. (some people do this as an outpatient procedure — respect to them, but I’m doing mine as an inpatient) It’s likely that I’ll need a blood transfusion or two during this procedure.

Other than the hair loss, there are several other side effects that I’ll deal with.. I’m told that my sense of taste will change. My immune system will take up to a year to fully rebuild itself, which is why I’ll be on lockdown for 2–3 months, and not really leaving my house or the hospital. I’ll also be really fatigued for several weeks. If I clock a fever at any point during this time, they will admit me into the hospital.

We’ll take inventory around day 90 to see how it did, hoping to see 0 Myeloma in my body (they can detect down to 1 cell in 100,000 with a bone marrow test). The goal is to be in Stringent Complete Response (no cancer via the normal tests), with Minimal Residual Disease (MRD) negativity (no cancer detected down to 1:100,000 cells).

The problem even if we achieve that goal is that during our Stem Cell harvest, we will have undoubtedly harvested some Myeloma Stem Cells. That’s one of the reasons why we do maintenance chemo (for up to 3 years) afterwards. Just to keep beating it down to keep it from coming back.

I’ll be taking 3 months off of work for this adventure starting with the harvest. Should be a fun summer… NOT!