Bone Marrow Transplant FAQs {or, I'm married to a stem cell stud}

My stem cell stud!

As we've approached the time for Jeff to donate bone marrow for Michele's transplant, many folks have asked what would be involved. Will Jeff be put to sleep? How do they extract the marrow? How will this affect Jeff? Jeff and I are the type of people who take a "less is more" approach to medical knowledge, but we've found this process to be really interesting. Of course, it's all personal with us, too, as we stand in awe that something as elemental to the body as stem cells can be removed from Jeff and placed in his sister in hopes of rebuilding her immune system.

Here are some answers to some of the questions we've been asked. I'll try not to get too graphic (mainly because I might get lightheaded, causing my laptop to fall onto the hard hospital linoleum) while giving as much info as I can.

Why does Michele need a bone marrow transplant?

Michele & Jeff pre-transplant

About a year ago, Michele was diagnosed with aplastic anemia. In itself, this compromises the immune system; combined with other conditions Michele has, it presented major challenges for her immune system. Earlier this year, doctors found that the aplastic anemia had progressed to MDS, which would most likely lead to leukemia. Essentially, Michele is no longer producing white blood cells. Her immune system is basically non-existent, but doctors are hopeful that a successful stem cell transplant will provide her the ability to produce new, healthy bone marrow, as well as providing a brand new immune system. 

How was Jeff selected as the donor?

Michele's two brothers both went through two rounds of blood testing to determine whether or not they were a match. Amazingly, both Jeff and Kevin were identified as 100% matches. The doctors ultimately selected Jeff.

Where will the transplant process take place?

Michele has been so blessed to be accepted into a protocol at the National Institutes of Health in Bethesda, Maryland. NIH offers her a team of specialists working together to help with each of her issues as they prepare her for the transplant process. Because of Michele's compromised immune system, she was already dealing with infection issues when she arrived. She was immediately admitted, with the team working around the clock to identify and treat each infection. Michele is not only the beneficiary of years of research done here at NIH, but other patients will benefit from the research protocol that Michele is a part of. And all
of this care has been provided at no charge to Michele.

As part of the donor process, Jeff has traveled to NIH twice: once for more screening and testing, and again for the actual donation. Again, this is done at no charge to Jeff or Michele, with some of the travel expenses even reimbursed.

How has Jeff prepared for the donation process?

First of all, he has tried to stay well. Michele's husband, Tim, consistently reminded Jeff to "Keep that blood healthy!" Second, for five days up to and including donation day, Jeff has taken injections of Neupogen to stimulate bone marrow and stem cell production. He had the option of going to the hospital to receive the injections (two shots once each day), or we could learn how to give them ourselves. Because it's quite a commute to NIH from where we are staying, we bit the bullet and learned how to do it. Additionally, he's tried to stay very hydrated.

How is the bone marrow obtained for transplant?

The apheresis machine.

This is one of the best things about being at NIH. Rather than being put to sleep and extracting the marrow by needle directly from the hip bone, Jeff went through apheresis. This is a process of filtering the blood; blood is removed from one arm (similar to a simple blood donation), run through a machine to remove the stem cells, with the remaining blood products returned to his other arm. As they return the blood, they also give the donor citrate (to lessen clotting) and calcium (to counter the effects of the citrate), as well as saline (for hydration). Quite a little cocktail flowing in!

Color matching during filtering process

After 45 minutes to an hour of prep, the actual apheresis process can take up to six hours, with the possibility of going through it all again the next day if the minimum amount is not collected. The doctor stopped by after only two hours and said that Jeff had produced about twice the normal amount of bone marrow. In fact, he said that we could actually stop apheresis then and have enough, but he wanted to keep the process going for a couple more hours to have enough for multiple transplants, if needed. The doctor originally calculated that 25 liters of  blood would need to be filtered in order to obtain the required amount of stem cells; only 15 liters were actually filtered. All of this is an amazing answer to prayer!

A nurse told Jeff he had very pretty cells!

At the end of the process, Jeff lost the equivalent of a pint of blood, and all of his blood products are naturally replenished within 24-48 hours. The side effects from the Neupogen shot begin diminishing within that time period and should be gone within two weeks.

How will Michele receive the transplant?

Michele will undergo chemotherapy and radiation for seven days beginning Memorial Day. She'll have a day to rest on June 4, and will receive the transplant on June 5, right in her hospital room. Following the transplant, she'll still need to receive transfusions for several weeks until her bone marrow begins producing. At some point within the first two weeks following the transplant, Jeff will come back to NIH to go through apheresis again, this time to donate granulocytes, a type of white blood cell that is integral to the immune system.

It's been amazing to be cheering from the sidelines through this process. We have confidence in God's sovereignty in all things; we are so blessed to, in this instance, see how His hand has orchestrated so many things to bring all of this together at the right time. He has been gracious to provide so many blessings along the way -- even Christian nurses (which, we've been told, can be rare at NIH).

We are so thankful that the Lord has answered so many prayers. Thank you to those of you who have been praying for Tim and Michele. Please continue to pray that Michele's new immune system will grow strong within her body, but not so strong that it will recognize her organs as foreign... it's a fine line. And may God receive glory in all that happens.