BMT Prep

Delivery of the Bone marrow transplant is now complete.

Author

Colin C.

Published

September 5, 2023

Modified

November 26, 2023

Main Changes

This Page, originally called, The Plan, is now good review of the steps taken. Materials here are soon to be updated with next phase of plans.

  1. BMT transplant date: Nov 9 Nov 14
  2. Updates to the countdown dates.

Following round four, Sam had a PET scan to determine how his cancer was progressing. Results indicated that we continue to move in the right direction. The cancer was reduced in size and remained in known locations – that is it had not spread anywhere else. However, it was also apparent that the rate of reduction was not enough to remove the cancer by the end of this chemotherapy regime.

Round six of Sam’s initial chemotherapy treatment is now complete. The PET scan results support the current plan to provide a bone marrow transplant. As the BMT date approaches Sam will have a number of tests to determine his baseline health before starting his bone-marrow-transplant protocol.

BMT Plan

BMT: Bone Marrow Transplant

Disclaimer

I feel I need a quick disclaimer here as I am not sure I have all of this right. In addition, the following dates are rough estimates from the medical team. In broad strokes I think most of the items below are pretty much there … dates and details are likely to change.

Overview

This is the plan as I understand it:

  1. Sam has completed the full six rounds of his initial chemotherapy.

  2. In preparation for BMT Sam will see numerous specialists throughout BC Childrens and the BC Cancer Clinic. The goal will be to create a strong baseline of Sam’s health going into BMT.

  3. Bone Marrow Transplant: Day zero is expected to be Nov. 14 .
    Following the current chemotherapy we will transition to BMT. The medical team refers to the actual transplant day as day 0. Activities prior to this day are count-down days and then the days following start counting up.

    • Days -22 to -11 (~Oct. 23): Radiation targeting whatever cancerous masses remain. The goal is to set the cancer back as hard as they can.

    • Day -6 and -4: Full body radiation to ensure Sam’s own immune system is completely removed – in preparation for replacing with the transplant/ graft immune system.

    • Days -3 to -1: Chemotherapy to suppress and remove Sam’s own immune system.

    • Day zero, currently planned for Nov. 14, Sam should receive the transplant. This is actually quite simple – like receiving a blood transfusion. The team will hang the bag of bone marrow products and pump it into Sam’s body via his central line.

    • Days 0 to 30 Sam will be in an isolation room with strict protocols. Tina and I, along with the medical team will be allowed in.

    • Days 31 through 90: If all goes well Sam will be allowed out of the hospital but is to remain close for regular check-ins.

Treatment Objectives

Challenges ahead

Below is copied from our Oct. 20st post

Radiation therapy – phase 1: Targeted radiation

The objective here is to directly attack the cancer and destroy as much as possible. There are both immediate and long term challenges. The radiation oncologist is trying to balance attacking the cancer while protecting the adjacent lungs which are very sensitive to radiation damage. In the short term there will be fatigue and pain – think of a time that you had a bad sun burn. Now take that sunburn and put it on the inside of your body. Sam may feel it most in his throat.

Radiation therapy – phase 2: Total body irradiation (TBI)

Next, Sam will undergo three days of total body radiation (TBI). This radiation will not target his cancer, rather it is undertaken to condition his body for the upcoming bone marrow transplant. TBI has the objective of permanently destroying Sam’s native immune system so that his immune system will not compete with the transplant.

There is a long list of potential side effects from the two radiation treatments. A few of these include: permanent scarring of the lungs, impacts on the thyroid, heart disease, changes to metabolism, secondary cancers, and others. Needless to say this can be scary.

This step, in conjunction with the following BMT Chemotherapy, mark a point of no return. Once these steps are initiated a transplant must happen for Sam to ever have an immune system again.

BMT Chemotherapy

The previous chemotherapy that Sam has had focused on targeting and removing the disease. This upcoming chemotherapy has a different objective. In conjunction with TBI it will be used to remove Sam’s own immune system. Following this chemotherapy any cells that produce/create blood will have been killed, and Sam’s bone marrow will be ready to receive the transplant. As with most chemotherapy drugs this treatment will likely make Sam feel ill.

The transplant/graft

On Nov. 14th Sam is scheduled to receive the donated bone marrow. The donated cells will need to establish or engraft to start providing Sam his new immune system. In the 2-3 weeks following receiving the transplant we will wait in anticipation for signs that the graft is taking hold. The whole transplant process will take place in an isolation room – Sam will not be allowed to leave until his new immune system takes hold. Tina and I will be able to gown-up and be with him.

This will be a hard number of weeks. Given the prior steps Sam will likely feel horrible for numerous weeks. It is highly likely that he will need significant intravenous supports for management of pain, nausea, engraftment of the new immune system, hydration, nutrition, and then potentially additional medication should he become ill without an immune system to support him. To provide all of these supports Sam may need upward of 15 different intravenous lines to all be connected at once. His current central lines should support most of this.

Once the graft takes hold it will start generating Sam’s new immune system and start fighting for him, including battling the cancer. However, this is a foreign immune system and steps will need to be taken ensure that the graft does not attack Sam – potential graft versus host disease. The graft also must remain aggressive enough to continually attach the cancer.

Choosing hope

There are many reasons to be consumed by fear – to allow the beast of Despair to have a foothold in our lives. Sure we have our moments of anxiety – but we choose hope. Sam remains a champion. We have also laid out some great ideas for his time in isolation – I hope he will feel well enough to take part in the activities we have planned.

We invite you to choose hope with us. It does make this journey easier knowing that you are there with us in mind and spirit. Please continue in your commitment to care and prayer.