Meet Laika

Skip this post if you're in the mood for humorous meanderings. I'm getting down to business here.

It's time for you all to learn exactly what's going on in this transplant, so pay attention. A bone marrow transplant is not exactly a transplant of the marrow (the spongy stuff itself), it is a transplant of the aspirate, or the blood and gunk inside the marrow that creates the marrow and blood cells. Used to be they would collect aspirate from the donor for transplant, which involved drilling into the donor's back, but nowadays they usually just collect the stem cells that make all that stuff right out of the blood stream via IV, or they filter them out of umbilical cords (after the baby is done using it, of course. I am not being infused with fetuses as some would have you believe).

Anyway, it goes like this: First, the recipient has their own marrow and cells destroyed by super high doses of chemotherapy and radiation (for me, 3 days of chemo and 4 of total body radiation, plus potentially another 5 days of cranio-spinal radiation). Then, the recipient is infused intravenously with the harvested stem cells from the donor, just like a blood transfusion through a slightly wider-than-normal central line. It takes about an hour and is, I'm told, anticlimactic. The stem cells cruise around for awhile, then set up shop in the marrow, and go right back to rebuilding the marrow and creating the blood cells. This takes about 10 days to 2 weeks. In that 2-week period, the transplant recipient has no blood cells at all and is totally dependent on transfusions of red blood and platelets and completely susceptible to infection because there are no white blood cells. Not to mention coping with the side effects of the chemo and radiation, which are nasty.  It's during this period when most of the transplant-related mortality happens, a number that is a good deal higher than one awaiting transplant would hope.

When the transplant is from cord cells, there are fewer stem cells than from an adult donation, so it takes longer for them to produce enough blood cells to fuel a viable human being. Adults have to be infused with 2 cords to begin with so there is a somewhat reasonable number of cells, but is still in that vulnerable state for up to 4 weeks or more, increasing the risk of transplant-related mortality significantly. However, one of the benefits of cord transplants is that there seems to be less chance of leukemia relapse in the future than in with adult stem cell transplants. Some hypothesize is has something to do with the competition between the 2 cords (as only one actually engrafts, and the other disappears).

In case you have been skimming STOP SKIMMING here because I'm getting to the whole point of this little lesson. Part of the benefit of being here in Seattle is the research they are doing on cord blood transplants. In one clinical trial, the researchers have figured out a way to "grow" more stem cells from one of the cords on a substrate before transplant, increasing their number by up to 150-fold, and cutting post-transplant recovery time in half. The unexpanded cord is somehow always the one that engrafts, however, eliminating the cord competition. Which led to another idea: implant with 2 normal cords for the competition (to prevent relapse) and one expanded cell to shorten recovery. This is protocol I am pursuing, and if insurance approves it, I'll be the first person to participate in this clinical trial. How completely insane am I? The researcher told me her plan and rationale, and I don't know what was wrong with me, but it sounded great. Sure, I'll be your space monkey! Still sounds like a great idea, even to my uber-skeptical mind. Strange how I have always wondered how they find the first person to try all this stuff. I thought they were probably duped (hence the title of my post; in case anyone gets it). But its really just about finding a better way.

In other news, Luna has a virus and my transplant team is going to kill me if I catch it and delay my transplant, which is only a couple of weeks away.  My cerebral spinal fluid is clear, no leukemia cells.  All my other test results are good and normal so far, but I still have a lot to go.  And something like a million of them are tomorrow.  Oh, and see this view?

I had to get to my appointment a HALF AN HOUR early to enjoy this view but I got about 10 minutes in that chair, for Pete's sake.

Sorry this one was boring, but that's the color of things these days. Although we've had a great time hanging out with our friends Jen and Mike who just moved here, and Rosa who is visiting. I could tell you about how the move to the bigger apartment was greatly delayed, but Brett might grab my computer and throw it out the window if I do. So all I have left is: good night! xo