A new stem cell transplant

Last summer I had an autologous stem cell transplant, meaning that the stem cells were my own; there is no problem with compatibility, no rejection: these are from my own body. This summer's procedure is different. This stem cell transplant, a mini-allogeneic stem cell transplant puts a donor's stem cells (rather than my own) into my system with the expectation of having them settle in and establish a new bone marrow. In my case the stem cells were donated by my brother Michael, who turned out to be a complete match. This compatibility is a very lucky thing for me. That Michael and I "match" means that I'm more likely to have an easy time of recovering. The difficulties with compatibility/rejection are minimized.

Here is the wild thing about transplanting Michael's stem cells: I get new bone marrow resulting from his stem cells, and a new immune system. It is this new bone marrow that has the potential to fix the three blood disorders, not meds, not chemo. I'm going to oversimplify (because I don't understand the mechanism well enough to really explain.) A new immune system means that I might not destroy my own red blood cells and the anemia goes away. A new immune system hopefully means that the cancer cells are not deemed "normal" or "self", are destroyed and the Myeloma goes away. The marrow being new should mean that normal blood cells will be produced and the myelodisplastic syndrome goes away. This is amazing almost magical. There are no guarantees that I will have success with fixing all that ails me. But the potential is there to do so. And it looks like my best chance to sort out all these problems.

The mini-allo transplant looks like a magic bullet, there must be a down side. Sure. For a long period of time I am at risk for infections of all sorts. The transplant leaves me with a new immune system, new as in that of a new born baby. I do not have resistance to any germs. I must be very careful about exposure to sources of infection, crazy restrictions about what I can eat, where I can go, what I can do. It is hard to imagine all the ways we can pick up germs. We don't even generally consider germs, we are healthy no matter what we do or where we go. For quite a while I am the virtual " bubble boy".

Another concern that comes along with the mini-allo transplant is rejection. Michael and I are as compatible as a donor and recipient can be, yet there is a concern with rejection, in the same way that an organ transplant recipient is likely to reject the new organ. In my case the rejection can also come from the new marrow and new immune system. The new marrow (Graft) looks out and sees my body (Host) and does not recognize it as 'self' and tries to reject it (my body.) Referred to a Graft versus Host disease, GVHD, this can be a tricky part of my recovery. Managing the GVHD is where the skill and experience of my medical team is crucial. I have tremendous confidence in my doctor and team at Dana-Farber. I don't believe there is a better transplant team anywhere to see me through this recovery.

By the way, I was admitted to Brigham and Women's hospital on June 29, 2007. I was discharged from the hospital on July 6, 2007. I'm home now. More about all that in the next installment.