Blood poetry part 2

During the 1950's, Dr. Thomas at the Fred Hutchinson Cancer Institute showed that stem cells re-infused into a patient would repopulate the bone marrow (think cells swimming in blood, finding bone, tunneling into the marrow, finding a home, making that home, quiescing, waiting for the day they will be needed). Five Yugoslavian nuclear workers with radiation damaged bone marrow received the first bone marrow (BMT) transplant in 1959 by the french oncologist Georges Mathe. Dr. Mathe then used BMT to treat luekemia patients. Fifty years later, more than 50,000 people had their bone marrow transplanted. Doctor's specializing in blood cancers, hematologists or hemoncs have an excellent (Damocoles' sword) tool in bone marrow transplantation. Even at diagnosis, Dr. T recommended the BMT has a treatment option with the potential of curative outcome; all other therapies give you time...

I remember reading 10 years ago about how bone marrow is harvested from either the sternum or the iliac crest. And then there is the image of Dr. T standing over me as he used a rather large (6 inches) corkscrew needle to aspirate my bone marrow to complete disease staging. Transplant therapy was one of several new therapies in clinical trials so I decided to try something off the medical grid and wait for the comparative results.

During the 10 years since diagnosis, BMT has changed names to ASCT (Autologous Stem Cell Transplant). The important distinction is that bone marrow releases stem cells into the blood supply (peripheral blood) in response to cytoreduction of blood components. Your marrow reads your blood. Blood has four main functions 1) oxygenation of tissues, 2) carry nutrients and wastes to or from tissues, 3) immune response to disease and 4) clotting. Hematapoetic stem cells (blood poetry) are the source of the cells that carry out these functions.

Myleoablative (destruction of the bone marrow) chemotherapies destroy all actively growing cells in the body. Because of the myleoablation, patients see their blood counts drop precipitously. Most patients become anemic ( too few red blood cells with their beautiful green hemoglobin bringing oxygen, bringing energy), all patients become neutropenic (unable to fight disease especially of bacterial origin), many require transfusions of platelets so they don't bleed out (night nurse Pam, " now if you blow your nose, do not(!) do it in a mainly way. Dab it, snuff it son, sniffle, but don't blow it!"). In addition to the impact on the blood, their is collateral damage on the alimentary canal (nausea, emesis, pain) an area where research continues to improve the patient experience.

The clinical experience of ASCT follows 3 stages: chemotherapy (6 days with the BEAM protocol), transplantation of hematapoetic stem cells, waiting for the transplanted cells to assume their rightful role, the re-constitution of the blood. Because of the extreme immunocompromise, the hospital is the only setting to play this drama out.

Reading about ASCT how can you not agree with Dr. T?

"Most people don't see the miracle it is".