Tuesday, March 23, 2010

BMT? SCT? WTH?

An awesome new friend that I gained through this MM journey suggested that I explain what the crap a bone marrow or stem cell transplant is, commonly called a BMT or SCT. I often forget that people don't eat, breathe and live maroon ribbon disease like Cassie and I do, so I often assume that everyone understands what all this means. My bad.

The good and bad thing here is that I am a dummy when it comes to this stuff. Good because I will be able to explain things in simple terms. But bad because I probably misspeak 10-20% of the time so you may get some wrong information. There is a reason why we called our blog MM For Dummies and not MM for Really Smart people. If ONLY Cassie were blogging, we probably could have gone with the latter.

First, here is a simple timeline of the BMT activity:
  • 3/16: NeoStar Catheter placement
  • 3/17: Cytoxan - Chemo
  • 3/18: Phil doesn't remember this day (thanks Ativan)
  • 3/21: Daily neupogen shots begin
  • 3/28: Last neupogen shot
  • 3/29: Stem Cell Collection (my stem cells), also called apheresis
  • 4/4: Christ is Risen, Hallelujah.
  • 4/5: Receive Melphalan - Chemo
  • 4/6: Phil checks into the hospital for a minimum of 15 days
  • 4/10ish: Phil's cells die
  • 4/10ish: Phil receives his Stem Cells back
  • 4/11+: Phil recovers until Phil is Risen, Hallelujah.
  • 2 months later (Take 2): Phil goes through this process again starting with Melphalan.
So what is a BMT and what will recovery look like? For most, the bone marrow transplant will take place only once and if they slip out of remission five years down the road they may go for a second. In my case and for probably 99% of the folks seen down at UAMS, we will be doing a tandem (back to back) transplant, roughly 60 days apart.

Here's how I describe the process for my autologous (my own stem cells) transplant/s. A BMT or SCT is not a surgery, though that seems to be a common misconception. They give me a nasty drug that I just learned is mainline therapy for fighting breast cancer, they start shooting me up with a crazy drug/protein that pump fakes the body out to produce an overabundance of stem cells and pushes the excess into my blood stream, they connect me to a machine where they pull blood out and dump it back into me all while collecting about 6 million of those baby stem cells, they give me the big gun chemo to kill everything and admit me the next day into UMHS, my old under-performing cells get dominated in roughly five days, they give me back a bag or two of my baby stem cells who have missed me, my counts start to return to safe levels during my two week stay in the hospital and they eventually kick me out and tell me to return home and live in a bubble now that I will essentially have no immune system, but hopefully also no cancer and lastly, if that wasn't fun enough the first time, let's do it again to complete the tandem. The End.

So now that folks understand that I am NOT about to undergo a surgery, the next question is what does the recovery timeline look like? First, for a single transplant, I typically hear that the majority of people are out of work for 3-6 months, closer to 6 although the line of work and how you feel are trump cards. For me, expect a six month recovery with a tandem..which of course will be subject to change based on whether I complete a tandem and how my body responds to the above process. My energy levels should be shot for a while and since I will be rebuilding an immune system and will be extremely susceptible to the most innocuous of germs , I will be chillin' like a villain in my house for a long while, trying to limit my exposure to infections that would send me back to the hospital. I hope to return from the ashes just in time for the 2010 Michigan Football season and the Big House Big Heart Run I ran last year.

So was that helpful? MM experts....feel free to humble me with correction where I have mis-spoken. I am new to all of this... -Phil

And here's Cassie's edit to Phil's original post:
To keep it even simpler, I'd just say:
1. They give you drugs to make your marrow over-produce stem cells and push them into your blood.
2. They pull your blood-and-stem-cells out, collecting the stem cells and replacing the blood. (A simple and painless but time-consuming process.)
3. They give you high dose chemo to kill everything.
4. They give you back your stem cells, which will graft back into your marrow, creating a new immune system over the next few months.

9 comments:

Candice said...

That was great! Thanks, but go to bed, that post was at 2:52am!!! :)

Becky said...

Wow, thanks for that. This is all so complicated that I feel like y'all must have degrees in biochemistry by now. All I know is that I am praying it all goes smoothly!

Laura said...

Awesome post guys. I've been doing a ton of reading on this as my mom (as you know) is on track for one of these badboys in the next month or two. Thanks for the constant education and I look forward to reading more tales of domination soon!
Regards from CA,
-Laura :)

Alysa said...

Thank you so much for explaining this. We were SO CONFUSED over here! This helps. And now we can do an even better job praying.

Mike said...

Pardon?....could you repeat that? lol

Laurel said...

You did good, Phil! (you too, Cassie) :) Great job on the play by play action of a BMT! I had mine in October and well, you just described the whole journey perfectly....you ain't no dummy! Stay strong, laugh when you can and know there are many prayers for your complete healing, and quick recovery.

tim's wife said...

You forgot the step where you get LOTS of attention from hot transplant nurses who fight over your file in the morning so they can be your nurse that day 'cause apparently being bald just brings out your big blue eyes even more
making you think maybe at the end of your 2 weeks, you'll take one of them home instead of your wife who looks like 5 miles of bad road after running back and forth taking care of you, the kid, your business and looks a whole lot like someone slipped HER the
Melphalan-Mickie instead of you!!!
Oh Sorry, I guess that step was just in Tim's transplant. Never mind....... ;o)

Cassie said...

Denise, that's AWESOME. I tell Phil all the time he's free to bring hot chicks home as long as they cook, clean and don't mind taking my kids to the park so I can nap. So far he's never taken me up on it... but it sounds like this SCT could change everything.

Amy said...

Thank you--you're right...I had NO clue. You guys explained that very well!

Praying for you and for everything to go JUST as it should!