As I have been preparing to be Nicole's bone marrow donor, I have thought a lot about her first donor, Laura, and my heart always fills with gratitude; she had marrow harvested directly from her pelvis bone in order to give a complete stranger a chance to live. Laura literally saved Nicole's life and because of her willing sacrifice, she is a heroine to our family. We haven't met Laura in person yet, but we have enjoyed becoming acquainted with her through email, and consider her to be part of our family. In a way, Laura is like another mother to Nicole.
Now I will share some details of the bone marrow harvest and transplant process.
When we first learned about the possibility of using Cathy or I as the donor, I was under the mistaken impression that the bone marrow from the parent could not completely replace the bone marrow in the child. That isn't true, and the purpose of the chemotherapy that Nicole is currently receiving is to completely destroy all of her bone marrow (and by extension, her immune system), and replace it with mine, the same as was done with her first transplant.
There are more potential risks and complications with a ‘matching’ parent donor than with an unrelated donor (which was used for her first BMT), and controlling graft-versus-host disease (GVHD) is an even more serious concern with a parent donor. A sibling donor is actually most preferred for a BMT, but none of Nicole’s 6 siblings were a match. The hope with using me as the donor is that (due to a certain, specific protein mis-match) my bone marrow will effectively fight and kill any residual Leukemia in Nicole’s body, thus preventing a future relapse.
Anyway, I will get some training on Wednesday (6/11) and then start giving myself Neupogen shots from this Thursday to next Monday. I’m told that the shots will make me feel achy, tired, run-down - basically flu-like symptoms. Some people also experience significant bone pain and require some pain management, and I hope I don't end up experiencing that.
I will undergo the bone marrow collection process next Monday (and again on Tuesday, if necessary – this would postpone the BMT to 6/18 because they have to do some post-processing on the bone marrow after doing the collection). My collection will be different and less invasive than the one that Laura experienced. It used to be that bone marrow had to be harvested directly from the bone, but a process has been developed recently, similar to dialysis, that takes blood into a machine that collects bone marrow stems cells from the donor’s blood and then re-circulates it back into the donor. It may be necessary to place a temporary extraction line in my neck if they cannot get a big enough IV in my arm. The actual collection process typically takes 5 to 6 hours (the entire volume of blood in my body gets circulated through the machine many times, one cup of blood at a time) and the goal is to harvest at least 10 million bone marrow stems cells from my blood. The doctor says most donors are fully recovered within a couple days after the procedure.
The actual transplant procedure for Nicole is quite simple; last time it was much like a blood transfusion – the bone marrow stem cells go into her bloodstream and then just know where to go and what to do. This time sounds like it may be a little different, with just a large syringe instead of an IV bag, but it is the aftermath of practically killing her and putting this new material into her body that is the long and difficult part.
Nicole will, of course, be totally immune-compromised for quite some time., and apparently even more so with a parent donor. If things go well, she’ll likely spend 7 – 8 weeks in the hospital, until she 'engrafts' and the GVHD is under control, and then she’ll be required to spend another 8 – 9 weeks in close proximity to the hospital, with frequent clinic visits and lots of round-the-clock medication. It is a minimum of 100 days after transplant before she will be allowed to go home. Clinic visits and medication continue, but taper-off slowly over the course of a year or more, as her immune system gradually strengthens. With a parent donor, they say it's about 18 months for the recipient's immune system to recover.
If the transplant fails (statistically a 4 in 10 chance), there’s not much else that can be done medically for Nicole, and it would prove fatal to her (which is the same outcome as if a transplant was not attempted). However, if the transplant is truly successful, then Nicole will be ‘cured’ of Leukemia, and all we will have to worry about are the long-term side-effects from the chemotherapy and radiation therapy she has received.
We still feel strongly that the Lord will again preserve Nicole's life, but we also understand that death is only a temporary separation of family. The Son of God suffered death, both physical and spiritual, in our behalf and triumphed over them. Because of our Savior's atoning sacrifice, all God's children will be resurrected, and if we live worthy of it, we will be bound together in family units in the next life:
For God so loved the world, that he gave is only begotten Son, that whosoever believeth in him should not perish, but have everlasting life. (John 3:16).
I believe in God, and I know that His promises are sure. How grateful I am for our Savior, and for Laura, and for everyone else who has and is helping to lift our burdens.
