Leverage, Preparation, and Science!

The word 'chemotherapy' used to made me think of severe wasting away. Of losing hair, weight, skin tone, strength, and often life itself. Chemo was and still is a universally scary word. It's like a 'near' death sentence. All to save a sick person's life.

When I used to hear the word 'transplant', I immediately thought somebody was getting an incision to takeout and replace a diseased or faulty organ. When compared to chemo this sounded like a slam dunk at getting another chance to live. I heard about heart patients running marathons within months of getting their new hearts. Who wasn't astonished to learn that whole cardiovascular systems (lungs and heart) can now be transplanted. Mind blown.

But when the the two ideas came into one conversation, I almost ran for the closest door. Chemo plus transplant scared the shits and giggles out of me especially when it came to my bone marrow. The two ideas couldn't exist in my mind because I wasn't someone who needed either, much less both.

I had no clue or did I?

When I was a kid I had a glimmer that something was off in my body. I used to scratch at my arms and legs incessantly. I'd go to sleep and wake up the bloodied fingertips. Weirdly enough, I'd dream I was one of those kids in the afterschool specials with leukemia (if you lived through the 70s and 80s then you know). The urge to ease the itchiness grew over the years to the point where I scarred up my arms between my elbow and wrist while scabbing up my shins below the knee. 

This is where I'll mention again that I grew up an ACES (Adverse Childhood Event Survivor). Kids like me went through hell and came out the side far stronger, far more resilient, but more susceptible to disease at an early age. 

I believed I was sick many many years before the actual fact but I didn't know just how sick I would become. During those tough times, I believed that bone marrow transplants involved cutting open the leg, slicing open the femur or hip bone to inject a slurry of the new bone marrow.

This may not have been the case in reality, but it scared my young naive mind into thinking, this is what I have in store for me? No, thank you.

Before 1957 (a great year for Chevy cars and trucks), doctors proposed doing just that. They had the idea of opening up the afflicted and transplanting actual bone marrow from donor to patient. Was it through the femur or the hip or some other bone structure? I don't. The whole idea of bone marrow transplantation was theoretical and under experimentation.

Thanks to some uber smart doctors they discovered that if they erased or eradicated the diseased bone marrow with preparatory chemo and radiation, they could intravenously feed the new bone marrow into a dying patient. No surgery. No butchery. Much less risk. Cool, right?

The early chemo and radiation treatments were tough, but over seven decades, they have greatly improved. Improved to the point that doctors can apply different levels of intensity to the preparation (chemo) process. The intensity depends on the patient. Young an strong patients usually get the strongest (highest level) intensity. Older and frail patients get the mildest (lowest) level. An athletic man in his early 60s with no major side diseases like diabetes, COPD, heart issues, etc., can usually handle a mid-level intensity chemo prep. These levels are also referred to as ablation (destruction) levels. Low ablation destroys the least amount of damaged bone marrow while high ablation cleans out everything.

High intensity isn't always needed. Given mid level chemo ablative techniques, the chemicals clean out most of the diseased tissue. This is where it gets interesting. The human body makes t-cells (white blood cells) to fight off disease. What if chemo can start the cleaning process and have the body's t-cells finish the job. This process of using t-cells as the cleanup crew is called 'host vs tumor' effect or leveraging a natural response to help with the process. In short, high-ablation isn't needed as long as some t-cells are around to finish the job. This is harder that it sounds because the same chemo preparation also causes a significant drop in t-cells. So it's a race against time to have one help the other. This i

At this point, I've talked up a storm about chemo prep and leverage. What about the transplant?

Once I understood that the chemo and my body would help removed my diseased bone marrow, I was left with one question. How do they get the bone marrow inside me?

The answer is so anticlimactic: intravenously.

No surgery and no butchery left me with a low risk of infection and death. Medicine and science have made it such that the process of getting bone marrow is relatively low risk. Truly anticlimactic.