Transplant procedure

I have been admitted today to begin my BMT. I thought I'd better devote this entry to explain a bit about what is involved.

Tomorrow morning, I go for surgery to have four things done: (1) my old Mr Hickman on my right comes out; (2) my new Mr Hickman goes in on my left; (3) the harvesting of my bone marrow for backup which involves drilling into my hips; and (4) drawing water from a tube put inside my lungs for testing. Following that, all going well, I start the pre-BMT conditioning.

The pre-BMT conditioning regime consists of intensive therapy with cytotoxic drugs. This treatment serves 3 functions: (1) to inactivate my immune system & minimise the chance that the graft/donor's stem cells will be rejected; (2) to markedly decrease the marrow cells so that the transplanted stem cells are able to lodge themselves in my bone marrow to engraft; and (3) to intensively treat the residual leukaemia cells so as to make the recurrence of the disease less likely.

My conditioning regime will lasts 8 days and I will be transplanted the day after the conditioning ends. Donor stem cells will be given to me through Mr Hickman into one of my main veins. This is just like a blood transfusion. The days prior to the transplant are labelled minus 8, minus 7, etc., with the transplant on day zero. The period after the transplant starts with day 1, day 2, and so forth, thereafter.

The immediate post-BMT period will be critical. By day 2 or 3, the effects of the intensive conditioning regime and the decrease in marrow function will begin to have their effects and I have to be kept in a protected environment to minimise contact with infectious agents. The suppression of white cells that normally prevent/combat infections leads to a very high risk of infection. Graft vs host disease (GVHD) [skin changes, gastrointestinal tract malfunction, liver injury, other organ system impairment] may be seen soon after the transplant. GVHD can sometimes be life-threatening but I will be given drugs to prevent or minimise it.

I will also get a new immune system with a new bone marrow through the Donor's stem cells. Hence, the first 90 days post-BMT are most critical because my old immune system would have been destroyed and I am waiting for my new immune system to develop. In the meantime, I will be most vulnerable to infections. It takes 1-2 years before the new immune system fully develops.

If you would like to know more about the BMT, please visit http://www.bmtinfonet.org/bmt/bmt.book/toc.html

My doctor says to expect stay 40-60 days in hospital. Fingers crossed and with lots of prayers, everything will go smoothly and I'll be home sooner than my transplant doctor expects!