10-5-10 Tuesday

Status: 9.25/10.  Feeling as well as I’ve been in a long time.  It’s gotten cool here, and we’re definitely into autumn.

Events:  On Thursday, we’ll check in one last time at the outpatient clinic, then await our admission day.

Comments:  So what is this bone marrow transplant thing anyway?  On Oct 13, I’ll be admitted to the hospital and start what is referred to as a “conditioning” exercise.  Sounds rather benign, but it is the chemotherapy regimen designed to destroy my bone marrow and with it remaining leukemic cells.  It will be accomplished using two drugs, which I haven’t had any experience with before, Fludarabine and Busulfan.  Busulfan is one of the oldest chemotherapeutic agents (around for more than 50 years).  Both drugs target stem cells (all the blood forming cells), and I’ll be on them for several days.  The dosage is meant to be lethal.

  I will not have any of my own marrow to grow back as I did with the two previous chemotherapy bouts, so the need for a replacement (my donor’s marrow).  About a week after my admission, my donor’s marrow will be harvested (taken by bone marrow biopsy under anesthesia) and couriered to Hopkins.  The donor cells (the transplant) is then given by IV, and the little cells find their way back to my bone marrow with the hope they will take up residence and become my new bone marrow.  How they find their way back to the marrow isn’t really known, but all bone has a vascular circulation with arteries and veins entering and leaving the marrow cavity.  I imagine as the donor cells are circulated through the body and bone marrow, they are attracted by some chemical affinity in the marrow and feel that they are home.  The process of the marrow finding its new lodging is called “engrafting.”

 The transplant day is called “day zero,” and all subsequent days are called Day 1, Day 2, etc.  The days before transplant when I’m receiving chemotherapy are labeled Day -4, Day -3, etc.”  I knew all that math would come in handy some day.

  As I await the engrafted marrow to multiply and start providing red cells, white cells, and platelets, I’ll need the same sort of transfusion and antibiotic support as before.  And the usual plan is to remain in the hospital until Day 30, and then transition to a special inpatient/outpatient clinic (IPOP) down the hall from the transplant ward for another 30 days.  I’m allowed to stay nearby in Baltimore for that month, going to IPOP each day for labs, transfusions, meds, etc.  Some days will be long, and as I recover some will be shorter.  Then if all has gone well, I can come home, with frequent visits to the regular outpatient clinic.  So at a minimum I’ll be in Baltimore for 10 weeks.

 Tomorrow, I’ll share the possible complications.




5 Responses to “”

  1. Andrea Tutle Says:

    Thanks again for the lesson. Many mixed feelings I’m sure. Akin to, but not exactly like a wedding or a birth.or considering the count down and count up a space mission. A big and much anticipated date. So many wonderful possibilities and some trepidation. Willl you be in a sterile environment for 30 days?

  2. Rick Davidson Says:

    OK, buddy, it’s go time. I know the next 60 will be a challenge, but I will be thinking about you. I will be up in early November and maybe if I can talk them into autoclaving me, I’ll try and get up to see you. By the way, do you know if you’re going to stay XY, or will you be developing your feminine side?

  3. Wally Schlech Says:

    We’ll be praying those little buddies will find their way home!

  4. bob price Says:

    Bruce, I’ve just refrigerated bottle of Champagine for the 4 of us dated about day 75 !! bob & karen

  5. wendy Says:

    you’ve done all you needed to very well to get to this point. WHile the rest won’t be a piece of cake..it will the remaining steps to make the cake.

    Here’s to your new birthday date that we’ll celebrate from here forward. I always knew you wanted to move your birthday from Dec 20th so you could get 2 sets of presents like the rest of the world, instead of the combined Holiday -birthday gifts. You’ll now have 3 birthdays..Dec 20th – the day of the bmt and the day Hopkins says… you’re cured!!!!

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