This isn't about me, but it is about the transplant process. Many if not most of you have probably seen the news story this week about the journalist and Good Morning America Anchor, Robin Roberts, who was treated for breast cancer and as a result of that treatment, developed a secondary disease called Myelodysplastic syndrome (MDS). This is a disease of the blood and bone marrow that used to be known as preleukemia and like all other related blood diseases affects your immune system.
What many people don't realize is that cancer survivors often die from another form of cancer, and often that cancer occurs as a result of their previous cancer treatments. For example, getting high doses of radiation to kill a mass tumor cancer can result in skin cancer. Sometimes these secondary diseases happen shortly after the treatment, sometimes they take decades to manifest themselves. If you're a cancer survivor who experiences this secondary disease decades after your original treatment, during your older years, you're lucky.
Robin's MDS appears to have manifested itself pretty quickly after her breast cancer treatment. Apparently her immune system was negatively impacted by the original treatment she received and is now comprised. To fix this problem they're going to kill off this faulty immune system and attempt to give her a new one. The method they're going to use to do this is a bone-marrow transplant. If you read the Basics page of my blog, I'll have discussed this in detail, but to summarize: Stem-cell and bone-marrow transplants are two different methods which accomplish the same thing - kill off a blood-related disease and regrow a new immune system.
Because Robin's immune system is already compromised, she will need a donor with an uncompromised immune system. Luckily her sister is a perfect match, so that the chance for tissue rejection is very low. The immune system is the organ of your body that recognizes which pieces belong and which don't. If it sees something 'foreign' to it, it sends out antibodies like white blood cells to attack the foreign object (like killing a virus).
Robin's sister will undergo an in-patient treatment under general anaesthesia where they will remove 1-2 liters of bone marrow (generally from her hip bones). The bone-marrow fluid removed will be refined and processed and then frozen for Robin's transplant. Directly after this step, Robin will undergo high dosages of chemo and/or radiation to kill off her immune system and the MDS inhabiting it. When that is complete, her sister's donated fluid will be put into Robin by a simple transfusion. The frozen bags will be thawed at her bedside and then infused via an IV drip.
The actual transplant process will be done in 1-3 hours in all likelihood. The stem cells from the refined bone-marrow donation will find their way back to their homebase (into the bone marrow) where they will begin to rebuild a new immune system, maturing into white blood cells (to fight infections), red blood cells (to transport oxygen) and platelets (to clot injuries). In 2-3 weeks, if all goes well, Robin's blood numbers (done via a CBC - comprehensive Blood Count - test) will rise from zero (in most cases) to their healthy levels, indicating the growth of a new immune system is underway. This process will take 1-2 years to be completed, just like with a new infant, however once the CBC numbers are high enough, the rest can take place as an out-patient.
In a perfect world this treatment would work and Robin's MDS would be irradicated. Hopefully that's the case. Unfortunately Robin will have to undergo additional chemo and/or radiation during the transplant, and that's another dangerous link in the chain. Who knows what the future holds in her particular case, but hopefully it will be a good outcome. The one thing we do know is that the medical community has made big advancements in the diagnosis and treatment of various forms of cancer and auto-immune disorders in the last century, and will continue to do so during this one. I have no doubt that the risks associated with bone-marrow and stem-cell transplants will continue to diminish as science advances and medical researchers identify new treatments and focus in on ideal mixes and doses. My thoughts are with Robin as she enters this new phase of treatment.
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