BMT: Transplant (Day 0)

Happy New Birthday Clark!

This marks Clark’s official second birthday.  Coincidentally, it is also Patrick’s birthday!  Happy Birthday Patrick!

The actual transplant was pretty straightforward.  They gave him some pre-meds (Benadryl, cortisone and Tylenol) to help manage any allergic reactions, and then intravenously pushed in the donated bone marrow over a 2 hour period.  Clark did amazingly well.  The Benadryl made him drowsy, so he was asleep the entire time.  The really good news was that he didn’t get a fever or show any signs of an allergic reaction.

I won’t say the process was stress free, as we were told that the bone marrow donor was a different blood type (ABO) and a different RH (-/+).  These two together represented a small (but higher) risk of allergic reaction.  So the nurses and doctors were in the room the entire 2 hours, taking temperature, heart rate, and blood pressure every 5 minutes.  Yes, every 5 minutes.

During the 2 hours of the transplant, we had time to talk to the doctor about what the process to extract and deliver the bone marrow is like.  It is a pretty amazing story.

There are several steps leading up to the donation of bone marrow where they check, and then double check they have a good candidate.  But we were really interested in hearing what happens from the extraction to when it arrived in the syringe for implant.  Especially since we were aware this donation came all the way from Europe!

The extraction process starts 14 hours before Clark’s transplant, where the patient is admitted to the hospital and prepped for surgery.  After prep, they are then taken into surgery and put under general anesthesia.  This is because the process of extraction is somewhat intrusive.  A needle is pushed into the lower back (if you have back dimples, this is exactly where they enter) and about 10ml of liquid is extracted.  Then the needle is pulled out, and re-inserted into the same place, but at a different angle.  They repeat this until they get enough liquid.  The amount depends on the size of the recipient, but in Clark’s case, they extracted about 500ml.  this means the donor had approximately 50 insertions.  Most likely 25 on each side of the pelvic bone.

After the liquid is pulled, some quick tests are done to ensure they have pulled enough stem cells, and then all of the extracted liquid is thrown into a cooler.  There are cases where the liquid has to travel longer, in which case a preservative is added and the liquid is frozen.  In our case, because Europe is only 10 hours away, no freezing is required. They just need to keep it at room temperature the entire way.

The cooler is then handed to a volunteer delivery person, who immediately jumps in a cab and goes to the airport.  The “courier” will have 2 tickets for flights to the destination city via 2 different airlines.  This is done just in case a flight is delayed or cancelled.  The bone marrow is carried by the courier the entire way, and they are not allowed to store it in checked baggage nor do they allow it to go through scanners.  This can be very stressful for the person charged with carrying the marrow.  The upside is that the volunteer gets a free flight to the destination city, and usually books some extra days of vacation before they return.

When they arrive in San Francisco, they immediately jump in a cab and drive to UCSF.  The UCSF lab receives the marrow and starts to process it further.  In our case, the bone marrow donor had a different blood type than Clark, and the lab needed to remove red blood cells before transplanting.  Due to time constraints, they can only do one pass of this process, which did leave a small risk of allergic reaction because of the residual blood cells.

Finally, the remaining liquid is loaded into an oversized syringe, and brought up to Clark’s room for transplant.  It is then placed into a drip line on his broviac, and administered.

A wild ride, all timed out and executed perfectly.

Another interesting fact we learned today, is that Clark will actually have 2 blood types.  More likely than not, the donor marrow will only constitute 80-90% of Clark’s bone marrow.  The other 10-20% will be his original marrow.  Both marrows will continue to produce their respective blood types.  This is actually considered a good thing, and will greatly help reduce the chance of Graft-vs-Host-Disease.  If the bone marrow were completely empty, and then the donor marrow took root (and was 100% of Clark’s bone marrow), this would almost guarantee GvHD. Having a tiny bit of the original marrow acts as a cushion, dramatically reducing the chance of GvHD.  Now, why not aim for 50-50% of old and new marrow?  Because the body will most likely just reject the new marrow.  It is a balancing game that is almost all science, but also a little art.

We are both blown away by the process, and in awe of the donor who went through this with us.  Thank you again to our generous and kind donor who gave their marrow for Clark.  We are very, very grateful for your donation.  Thank you!!