The Talking Cure: Episode 5 – The Bone Marrow Transplant pt.1


Brian Allen and Andy Guss  talk about Andys bone marrow transplant.

Topics:   These will be covered in part 1 and 2

  • What is a BMT and why/when are they used?

    • Mega-dose chemo and radiation for advanced stage or recurrent cancer

    • The actual transplant is just a blood transfusion

    • Needed to survive the treatment for the disease, not the disease itself

    • Different kinds of transplants but fundamentally the same in effect

    • Example: Stem Cell Transplant is a type of BMT

    • BMT vs. SCT (benefits and limitations)

    • Cost is upwards of $250k, covered by insurance

  • The Procedure

    • Installation of catheter (required)

    • Generally some amount of outpatient chemo prior to the BMT

    • Harvesting of donor material

      • Bone Marrow (surgical)

      • Stem Cells (pheresis)

        • Clinical Trial

        • Neupogen/human stem cell factor

      • Cryogenic storage until needed

    • Inpatient stay is 3 to 6 weeks

    • Recuperation is 4 to 6 months

    • Day of admission

      • LOTS of paperwork, mostly legal

      • Agreement/Submission form with tons of disclaimers

      • DNR (Do Not Resuscitate)

      • Power of Attorney

      • A lot of nervous waiting

      • Protocol doesn’t start until midnight of the first day

      • Last decent meal for a long time

    • Protective Isolation

      • Private room

      • Private bath (baths only, no showering)

      • Giant hepa-filter machine in room

      • Protocol for visitors (scrub up, gown, mask, gloves)

    • Chemo

    • TBI (Total Body Irradiation)

    • Meticulously timed down to the hour

    • Minus Days (-10, -9, -8…) are for chemo/radiation

      • Motherfucking awful – Round 1

      • Gets worse as days go by

    • Day 0 is the day of the transfusion

      • Emotional but painless

      • Some mild nausea

      • VERY strict protocol

      • Risk of rejections (BMT vs. SCT)

    • Plus Days (+1, +2, +3…for as long as necessary) are for harvesting of marrow/stem cells

      • Motherfucking awful – Round 2

      • Gets better as days go by

      • Waiting Game

      • Once blood counts are at safe levels you may be discharged and catheter may be removed

    • Discharge

      • More paperwork

      • Release instructions for home care

      • Under house arrest for two weeks

        • Daily visit from nurse

        • Vital stats

        • Blood draw

        • Neupogen injection

      • And so begins the long recuperation

      • Follow-up exams every 3 months for 3-5 years, then every 6 months, once a year after 8 or so years

      • Bloodwork, physical exam, x-rays, no meds

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