I am writing this column 30 days after my donor stem cell transplant.

The road to this point has been far from easy.  Nor do I believe that I am anywhere near “out of the woods” as far as recovery.

However, I am feeling pretty good about where I am at right now and about my decision to go forward with the transplant.

First, a little background:

I have written about this in some of my previous posts.  Since being diagnosed about 6.5 years ago, I have undergone just about every treatment available for multiple myeloma.

I have had two autologous stem cell transplants (that is, transplants using my own stem cells).  The first was after my initial therapy after my diagnosis, and the second was about 1.5 years ago after a bad relapse.

About 10 months after the second transplant, my myeloma began to progress again in a very aggressive way, becoming resistant to just about everything that we tried.

One of my myeloma doctors, Dr. Ken Anderson from the Dana Farber Cancer Institute in Boston, whom I was seeing for second opinions, began to strongly push the idea of a donor (or allogeneic) stem cell transplant.

Autologous stem cell transplants, which use your own cells, are fairly standard treatment for multiple myeloma. However, the role of transplants using stem cells from a donor remains much more controversial for multiple myeloma.  In particular, the role in patients with relapsed or refractory disease is unclear.

In fact, not all of my doctors agreed that this was the best way for me to go.

It seemed, however, that I was in pretty dire straights.

I had read all the data on the survival of patients who had become resistant to all the treatments that I had been on.  It seemed that even with another clinical trial drug, and we did discuss Kyprolis ^[1] (carfilzomib), elotuzumab ^[2], and others, that the best we could hope for would be a few months before my myeloma would progress again.

None of the experts seemed to feel that any of the new drugs would fundamentally alter the course of my disease.

Faced with this prospect, the idea of the donor transplant began to make more sense.  I understood that the donor transplant was high risk, particularly in “heavily pretreated” patients, as everyone seemed to like to refer to me these days.

I was often quoted a mortality rate of about 20 percent for the process.  But what was 20 percent versus the alternative, which seemed to me to be a slow inevitable demise.

The donor transplant seemed to at least offer a chance for some longer-term meaningful disease control and even, dare I say, a cure.  It was in my mind my last best shot.

The one catch is that almost everyone agreed that in order for the donor transplant to have any chance of working, I needed to go into the process with fairly good disease control in order to give the donor cells a chance to take over and fight the myeloma cells (the graft-versus-myeloma effect).

Fortunately, I responded surprisingly well to a couple of cycles of chemotherapy with Velcade ^[3] (bortezomib), thalidomide ^[4] (Thalomid), and dexamethasone ^[5] (Decadron) plus cisplatin, doxorubicin ^[6] (Adriamycin), cyclophosphamide ^[7] (Cytoxan), and etoposide (known as VTD-PACE).  It brought my myeloma under control enough to make the transplant possible and for the transplant team at Moffitt Cancer Center, where I am being treated, to be onboard with Dr. Anderson.

The donor for an allogeneic transplant can be a sibling, if they are a match, or a matched unrelated donor from an international database.

Despite having two sisters, neither were a match for me.  I did have several perfect matches in the database, and a donor from Germany was found.

There was an excellent article ^[8] in The Myeloma Beacon last week about a German study of donor transplants followed by Revlimid ^[9] (lenalidomide) maintenance therapy.  The article outlines some of the details of the process.

In an autologous stem cell transplant, high dose chemotherapy is given to wipe out the immune system and any cancer cells, and than the patient’s harvested stem cells are given back to jump start the immune system again.

In a donor transplant, the process starts out the same with high dose chemo.  However, since the cells come from a donor, there is the issue of the new cells trying to fight the cells in your body (graft-versus-host disease).  This can affect almost any organ system and requires long term immunosuppressive medications and very close monitoring.

About a week before the planned day of admission for my transplant, I developed a mild upper respiratory infection.  The transplant team was adamant that we could not proceed until the virus was completely cleared from my system.  This set everything back close to a month.

Finally, the big day did come, and I was admitted to the Bone Marrow Transplant Unit at Moffitt.  I received five days of chemo, and after a day of rest, I received a transfusion of the donor cells and was also started on immunosuppressive medications.

Similar to autologous stem cell transplants, it takes about 10 to 14 days for the new cells to engraft or to take hold in the bone marrow, but the recovery from the donor transplant is much more difficult and complicated.

The fatigue is worse, the number of problems that can arise is much greater, and the intensity of the care and monitoring is also much greater.

During my almost three weeks in the hospital, I hit several bumps in the road, which I will write about in future columns.  Fortunately, my transplant doctor Dr. Claudio Anasetti and the transplant team at Moffitt seemed to be on top of everything, and they very quickly headed off problems as they arose.

So, here I am at day 30.  I am home recovering, feeling like I am on the right track and that I have left nothing on the table.  No matter how it turns out, I have done everything that I can do to give myself my best shot.