Bone Marrow Transplant

Think of  it as a clean slate. As clean as it can get.  Chemotherapy wipes out as much of the cancer as possible. It puts the patient in remission as far as their numbers on paper. But with multiple myeloma, because it is incurable, it will start growing and coming back in a very short period of time. So the chemo remission is followed by a bone marrow - now called a stem cell -  transplant. This is done by collecting a person's own cells to give them back (stem cell collection). They are then hospitalized and given a mega dose of chemotherapy to kill off their remaining cells to get rid of the rest of the cancer cells, but the good cells go too.  So they are sick and weak for a few weeks.




Stem Cell Collection


The week before they collect the cells, I inject Scott every morning with a medication (Neupogen)  that makes his body produce lots of healthy cells very quickly for collection. Along with that, a brand-new medication, aptly named Mozobil, is now available that I inject him with at night that helps mobilize those cells so they move out of the bones more easily so by morning there are more to collect.  We were told this drug was very expensive and he only gets one injection each night before stem cell collection. If they collect enough cells the first day, he only needs it one night. When he picks it up from the pharmacy and pays our co-pay, he shows me what it would have cost - for four tiny little vials that we may only need one of.


GOAL: They need to collect 10 million cells for the transplant within 4 days. If they can get them all in the first day, he doesn't have to go back.  When he did this the first time in 2007, he got all 10 million the first day. We are so hoping it will be the same, but with the damage caused by the recurrence of the cancer and being five years older, they say he probably won't get enough in one day.


Day 1 Stem Cell Collection (Medical term - Apheresis). I give 2 shots Neupogen at 7:00 am. Scott goes in for Apheresis. 


To collect the cells, they hook Scott up to a huge machine similar to a kidney dialysis machine through the catheter in his chest  They cycle all the blood in his body through the machine a total of 4 times over a 6-hour period, giving him fluids, calcium supplements, checking his blood counts, etc. throughout the day to make sure everything is normal because along with the stem cells they collect, he loses some nutrients in the blood they have to put back in.  He comes home, rests and waits for the phone call to see if they got enough cells.  7:00 PM the phone rings. 


VERDICT:  1.7 million cells. 


That sounds amazing, but not even close. He knows he has to go back the next day.  9:00 pm, exactly 12 hours as directed, before apheresis,  I give him the $$$$ Mozobil shot that night and pray tomorrow will be the last day for him.