Transplant 101 – The Aplastic Anemia Cure

A brief update to my post from August 9th (“An Oeuf – Aplastic Anemia and Fertility”):  it is just over one week since my egg extraction.  The procedure went well, although we only retrieved 5 eggs.  Hopefully, should I be infertile after my transplant, those 5 little eggs will be all I need to have a baby.  I am still a little ouchy and swollen, but am otherwise doing great.

My bone marrow transplant is approaching!  I am still awaiting the confirmed date, but it looks like it will be around September 23rd.  My donor has had her pre-testing, and now my coordinator and the transplant board are navigating the quagmire of operating room scheduling.  My donor will be put under general anesthesia while the marrow is extracted (hence the need for an OR), and she will spend the subsequent three days in the hospital while she is monitored for pain and infections.  As I’ve stated before, donating bone marrow is one of the most generous, selfless gifts one can give.

Aplastic Anemia Blog - Kitten

This is lazy writing.

I have been asked quite a few times about the mechanics of bone marrow transplant procedures, and while I answer as best I can, I have decided to directly reference the entry on BMTs from the Be the Match website (this is also known as lazy writing).  Note – I have made minor edits to the text below in order to condense the information and make it easier to understand.

I also want to encourage those of you who have questions about any of the information I share below, or anything else to which you would like me to respond, to contact me at aplasticanemiawarrior@yahoo.com.  I would love to hear from you!  No topic is off-limits and I would love to compile a Q&A at some point with reader questions.  Don’t be shy, and don’t worry that I won’t respond or am too bogged down with this disease to talk about it.  I love talking about it, because A) this is my life now, B) I want to help and educate, and C) I love talking about myself (my favorite subject).

Now, without further ado, Transplant 101!

The Preparative Regimen

To prepare your body for a bone marrow or cord blood transplant (also called a BMT), you will receive a pre-transplant treatment called a preparative regimen or a conditioning regimen.

For your preparative regimen, you will receive high doses of chemotherapy and possibly radiation therapy. This high-dose treatment destroys diseased cells in your body. The treatment also destroys blood-forming cells in your bone marrow to make room for your new cells and destroys your immune system so it cannot attack your donated cells after the transplant.

The preparative regimen may last four to ten days. The length and strength of this treatment depends on your disease, your age, any previous treatments you may have had and whether your disease is active. You may begin your preparative regimen even before you enter the hospital for your transplant.

All preparative regimens use chemotherapy. Some also include radiation to the whole body. This is called total body irradiation (TBI). A single TBI treatment lasts from 10 to 20 minutes. TBI treatments may happen all in one day, or they may be spread out for up to 7 days, depending on the total dose you will receive.

Transplant Day

When you have a bone marrow or cord blood transplant (also called a BMT), the day you receive your donated cells is often called “Day Zero.” Patients have different feelings about this day. For some patients, it is a scary time. For others, it is a time of celebration.

Day Zero — transplant day — usually comes one or two days after you complete the preparative regimen. You may be tired or have other early side effects from your preparative regimen. If you receive cells donated by an adult donor, your donor completes his or her donation either on Day Zero or the day before.

The donated cells arrive in blood bags, just like the ones used to collect blood from blood donors. The color and amount of fluid depend on whether the cells were collected from marrow, peripheral blood or an umbilical cord and whether the red blood cells were filtered out.

The cells in the bags are infused (put into your body) through an intravenous (IV) line, much like a blood transfusion.  The infusion process takes about one hour, sometimes longer, depending on the volume of cells. The infusion usually does not hurt. A nurse will watch your blood pressure and pulse and watch for any reactions while you are getting your new cells. Some people have mild side effects like those of blood transfusions. These side effects do not last long. You will be awake to receive the donated cells, although you may be mildly sedated.

The donated cells “know” where they belong in the body. They move through your bloodstream to settle in your bone marrow. This is where the donated cells will begin to grow and produce new red blood cells, white blood cells and platelets. This is called engraftment.

Waiting for Engraftment: Days 0-30

After your bone marrow transplant (also called a BMT), you will have low blood counts. This means that you have fewer than normal numbers of red blood cells, white blood cells, and platelets. Over time, the donated cells you received for your transplant start to grow and make new blood cells. This is called engraftment.

Engraftment is an important milestone in your transplant recovery. You will have daily blood samples taken while you are waiting for your donated cells to engraft. The blood samples will be given a complete blood count (CBC) test. The types of blood cells that are counted to measure engraftment are neutrophils, which are a type of white blood cell that are important for fighting infections, and platelets, which help control bleeding.

Until your donated cells engraft, you may get red blood cell or platelet transfusions. On average, transplant recipients get one red blood cell transfusion a week, and two to three platelet transfusions a week.  You may also get growth factors — drugs that help the body make more blood cells. Growth factors may help donated cells engraft more quickly.

Until your donated cells engraft, you will have low counts of all types of blood cells. You will have very few white blood cells to fight infections. This means you can get an infection easily and infections during this time can be serious, even life-threatening. Your transplant team will take steps to protect you from infections. You will be at risk for infection for many months, but the period before engraftment is a time of especially high risk.

In the first 30 days after your transplant, you may also have some side effects from the preparative regimen you received before your transplant. Some of these side effects can be serious, and others are less serious, but can be painful or uncomfortable.

Early Recovery: Days 30-100

After you receive a bone marrow or cord blood transplant (also called a BMT), your doctors will watch your health carefully. Especially during the first 100 days after your transplant, you are at risk for complications. You and your transplant team can take steps to prevent some of these problems. Your doctor will work quickly to treat complications that do occur.

After your donated cells engraft (begin to grow and create new blood cells for your body), your blood cell counts will begin to go up and your immune system will become stronger, although it will be weaker than normal for many months. Your transplant team will still care for you and watch you closely for complications. Sometime during the first 100 days, you will probably be able to leave the hospital and receive your care as an outpatient.

Transplant centers have different plans for patient care and the stage of recovery at which transplant patients transfer from the hospital to outpatient care varies. In your first weeks or months after you leave the hospital, you will go to the outpatient clinic often, perhaps even daily, for care.

Most infections happen in the first 100 days after transplant, but they remain a risk as long as your immune system is weak. Infections can be very serious, so your transplant team will watch you closely for signs of infections. Especially after you leave the hospital, you and your caregiver will also need to watch for signs of infection.

Complications

Graft-versus-host disease (GVHD) is a common complication after an allogeneic transplant (which uses cells from a family member, unrelated donor or cord blood unit). In GVHD, the immune cells from the donated marrow or cord blood (the graft) attack the body of the transplant patient (the host).

GVHD can affect many different parts of the body. The skin, eyes, mouth, stomach and intestines are affected most often. GVHD can range from mild to life-threatening.

There are two forms of GVHD:

  • Acute GVHD develops in the first three months post-transplant.
  • Chronic GVHD usually develops after the first 100 days post-transplant, but signs and symptoms can appear earlier.

Graft Failure or Rejection

Doctors call the cells you get during your transplant a graft. Graft failure is when your body does not accept the donated cells. The donated cells do not make the new white blood cells, red blood cells and platelets you need. Generally, doctors define graft failure as no signs of engraftment by the 42nd day after transplant.

Graft failure is a serious complication, but the rate of graft failure is usually low (about 5%). However, a number of patient and disease-related factors can affect this risk. The most common treatment for graft failure is another transplant. The second transplant may use cells from the same donor or from a different donor.

I decided to include the information on graft failure and graft vs. host disease, since I have been asked about the risks or possible complications of a BMT.  My inclusion of that information in no way indicates that I believe those issues will apply to me.  I am fully aware of the possible negative consequences of the procedure, but am in no way overly concerned.  I will simply handle situations as they arise, and hopefully there will be no issues whatsoever.

Finally, I plan to post at least one more entry before I begin my BMT preparative regimen, but I also hope to update this blog daily (or as close to it) during my procedure and recovery.  It may only be one or two lines (i.e. “I feel like rabbit shit”), but I want to be as active as possible during the process in order to let you know how I am doing and give a real-time account of my transplant.

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2 Comments (+add yours?)

  1. Adrien
    Aug 29, 2011 @ 23:10:42

    Hey, you stated in a much more direct way what I was trying to communicate, thanks, I will recommend your site to my friends.

    Reply

  2. Trackback: It Comes from Rabbits?! The ATG Experience – Part Two « Aplastic Anemia Blog – Marrowly Rolling Along

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