BMT 101

My survivor jewelry!  My nephew Alex (a cancer survivor himself) made me the braided bracelet, and my mom (with Lucas's input) ordered the "Team Janna" bracelets.  Makes a girl feel loved. 

 A lot of you have asked or may be wondering what this whole bone marrow transplant process entails.  This is how we understand it...

I will officially begin this process this Friday (August 9).  I arrive at the hospital at 8:00 for my first total body radiation treatment.  Friday is day -7.  I will have four days of total body radiation twice a day, a day of chemo, two days of rest, then the infusion of my brother's stem cells on Day 0 (August 16).  Andy will begin his shots on Day -5 (Sunday) to spur his bone marrow production.  They will start collection next Thursday, in which his blood will be drawn, the stem cells that were created in his bone marrow and spilled over into his blood will be filtered out, then the remaining blood will go back to him.  This may take 2 days to get all that they need.  Those stem cells are then given to me through my central line just like a blood transfusion.  

The amount of radiation and chemo I will be given are to (1) destroy any remaining leukemia cells, and (2) destroy my bone marrow to make room for Andy's.  Without a transplant, my bone marrow wouldn't recover and I wouldn't survive.  

After the stem cells are infused, we wait.  While I am treated for and recover from the side effects of chemo and radiation, I'll receive blood transfusions as we wait for Andy's cells to make their way into my marrow and start making new blood cells.  I'll be neutropenic at this point, as my white blood cells (and red blood cells and platelets) will be completely wiped out, leaving me without an immune system. They will know engraftment (Andy's cells have begun producing new blood cells in my marrow) has happened once my white blood cell count reaches a certain level, usually 2-4 weeks after infusion.  I'll be able to go home when my white blood cell count stays stable for 3 days, and I meet several other stipulations (no infections, eating 1/3 of my daily caloric needs, etc.).  I will continue to be closely monitored for the first 100 days, which are the most critical. During this period, I will be on immunosuppressive drugs to prevent GVHD (graft versus host disease).  Because we are replacing my immune system with my brother's, there is the possibility that Andy's cells (graft) could recognize my body as foreign (host) and attack.  It is necessary, then, to suppress my immune system to avoid this as much as possible.  There is always a risk of GVHD...but it is a  necessary risk, as the benefit of the GVL (graft versus leukemia) effect outweighs the risk.  So, while Andy's immune system may fight my body, it will also fight the leukemia.  Hopefully I can experience minimal GVHD symptoms.  

Even when I'm out of the hospital, then, I will still have to take many precautions to avoid getting an infection my body can't fight.  I also have to stay within 30 minutes of the transplant center for the first 100 days.  Cory and the older boys will return to Virginia for work and school at the end of this month, while me and the babies stay here at least through Day 100 (November 22).  At that point, I will continue to be monitored by my oncologist in DC, and will wean off the immunosuppressive drugs over 6 months.

Those are the basic facts.  As far as our feelings about all this?  That's for another post. :)

Thank you for your love, support, and prayers.