What is a "Stem Cell Transplant"?

"I don't know what any of that means. But, GO AMY!!" was the reply to an email update I sent.

I'm writing again this week. Mostly because there are a lot of people who have no idea what this all means. A 'Stem Cell Transplant'. Stem cells are kind of in the news again. They were also in the news several years ago. Skip ahead 2 paragraphs if you want to read more about a Stem Cell Transplant.

In the news recently because of the use of stem cells as therapy in a couple of high profile ex-football players. This from the Mayo Clinic website: "Stem cell therapy, also known as regenerative medicine, promotes the reparative response of diseased, dysfunctional or injured tissue using stem cells or their derivatives." Further "Stem cells can be guided into becoming specific cells that can be used to regenerate and repair diseased or damaged tissues in people." My brother is an equine vet and uses stem cells for orthopedic repair/therapy as well. Equine = horse.

In the news in the past because of limitations placed on embryonic stem cell research and/or funding for such research. As we are apt to do here (read in the US), opinions about this were generally polarized or politicized to whether you were left or right leaning. And, based on my reading and understanding a fair bit of mis-representation of the source of the cells. I will leave it at that.

Stem Cell Transplant (SCT). The two items above are NOT a SCT. A SCT is similar to an organ transplant because Amy's current bone marrow will be replaced by new bone marrow. Like a cystic fibrosis patient who might get a lung transplant (I use this example bc I know someone who has), Amy will get an infusion/transplant of cells that will become her bone marrow.

A variety of factors come into play as to whether or not a patient might have a SCT: age, stage of disease, overall health, risk category, etc. I've blogged a bit about it before. For Amy's AML, with current treatment methods, a SCT is the best path forward. So, what exactly happens? It is, a remarkable and unremarkable process all at the same time. As a follow-up to this week's earlier blog.

Today May 22 Amy has had a test dose of the chemotherapy that she will get next week. That has entailed a small infusion of the chemo and about 12-15 tubes of blood. We will have been in the hospital for 12+ hours today.

May 28 she will start a 4 day course of chemotherapy. This is a very intense type of chemo that is designed to effectively wipe out her existing bone marrow and make room for the new cells. The bone marrow produces red and white blood cells as well as platelets. Red cells carry oxygen. White blood cells are the defense mechanism from infection, virus, etc. and eventually help create our immune system. Platelets allow the blood to clot. Those are all very simplified descriptions.

June 1 she has a dose of total body irradiation. That is to help kill any existing leukemia and white blood cells that may still be in her system, and it will also further suppress her immune system.

June 2/3 she has 'rest days'. Rest because there is no treatment scheduled, and she will very likely feel like a steaming pile of poo.

June 4 she receives her SCT. Unremarkable because it is just like a platelet or red blood cell transfusion, hence the picture. They hang a 2 bags of blood products, and they get infused into her system via an IV. Remarkable because it is the way to cure her Leukemia.

After that, hurry up and wait. Wait for the new cells to engraft and replace the bone marrow that she had that over-produced immature cells (Leukemia cells). This process can take a few weeks. Amy is part of a trial where some of the cells are treated with an agent to speed up the engraftment process.

I will continue to post along the way as the above is 'just' the SCT and not the process after. Here is some info about 'The Transplant Process' from the American Cancer Society. Here is a write up from MD Anderson as well.