Transplant Schedule Firming Up

• Barring any unanticipated delays, I’ll start the conditioning regimen for my myeloablative stem cell transplant next week, on June 3.  I’m scheduled to get three days of chemo (fludarabine and cytoxan), a “rest day,” and then four days of total body irradiation (TBI).  The goal of the conditioning is to eliminate (ablate) my existing bone marrow (and immune system), and kill remaining leukemia cells in my system. 
• On or about June 11, after the chemo and radiation conditioning is complete, I’ll get my new stem cells via a transfusion.  The idea is that these new stem cells (from two units of umbilical cord blood donated by parents after the birth of their children in New York state and somewhere in Italy) will then be able to engraft in my marrow space, begin producing new blood cells (and thus a new immune system for me), and eliminate any lingering remnants of my leukemia.  I’ll be getting two cord blood units because research has shown that total cell volume–even when achieved by combining two separate cord blood units–is crucial to the success of the engraftment process.  (The amount of stem cell-rich cord blood that can be collected after the birth of a single child is, not surprisingly, pretty low compared to the volume of stem cells that can be harvested from an adult donor.)
• Remarkably, the two cord blood units only need to be matched to me (and to each other) in four out of six major HLA types.  Because umbilical cord stem cells are “naive,” they are able to demonstrate significant flexibility and adaptability as they engraft and establish a new immune system.  By contrast, adult stem cells need to be matched in ten out of ten HLA types to ensure a comparable level of success.
• The chemo and radiation will take a lot out of me.  While they will target my faulty marrow and the leukemia it is producing, they will also affect other fast growing cells in my body.  It sounds like one of the least pleasant side effects of the conditioning will be the mucositis that results when the cells lining my mouth and GI tract temporarily stop regenerating.  Fortunately, the medical team here at the Hutch is tremendously experienced at dealing with mucositis, and all of the other side effects and complications that can crop up, so I feel like I’m in good hands.
• After the June 11 transfusion of my new stem cells, it will take anywhere from 10-30 days (the sooner the better) for the new cells to engraft.  Once the cells have engrafted, and as long as my blood counts are starting to recover and I am able to drink, eat, etc., I will be released from the hospital and be able to head back to our apartment near the out-patient clinic.  The best case scenario for my upcoming hospitalization is probably a 25 day stay; more likely, I could be in for 30-40 days.  It’s not my idea of the ideal way to spend the beautiful month of June, but considering my options, I’m certainly not going to complain.
• It’s been a long haul to get here, so we’re eager to get started.  There’s lots of worrisome stuff ahead (mucositis, the possibility of graft versus host disease, the nagging fear of relapse, and probably many things I haven’t even begun to consider), but it’s good to be moving ahead towards a cure.
• Thank you for your messages of support.  Lisa, the girls, and I are grateful for them all.