January 19 is the anniversary of my stem cell trans­plant. I celebrate the “birthday” of my immune system each year. This year was the 9th such celebration, which seems fairly amazing to me.

Before my trans­plant, I had read about a survivor who was hoping to get two or three years of remission from his trans­plant. His account really set my ex­pec­ta­tions. Of course, I now realize that things are not that pre­dict­able with myeloma: some people do better, some worse.

I was really lucky, getting seven years without treat­ment after my trans­plant. The trans­plant was in 2007, and I did not start treat­ment again until the beginning of 2014. My trans­plant was definitely a sig­nif­i­cant step in my life with multiple myeloma, marking the end of my initial ther­apy and the start of a return to an approximation of normality.

As virtually everyone who is reading this already knows, the term “stem cell trans­plant” is somewhat of a euphemism. The stem cells do not attack the disease itself. Rather, they prevent the “high-dose” chemo­ther­apy that is admin­istered beforehand from achieving a Pyrrhic victory by killing not only the cancer but also the patient. (Consequently, another term for such a trans­plant is “stem cell rescue.”)

The high-dose chemo­ther­apy that is admin­istered as part of the stem cell trans­plant process attacks and kills stem cells that continually produce blood cells, in­­clud­ing plasma cells as well as red and white blood cells. Without white blood cells, the patient would have no immune system and could not survive. Re-infusing the collected stem cells into the patient’s body shortly after the high-dose chemo­ther­apy ensures that blood cells con­tinue to be produced and that the immune system is rebuilt.

On the one hand, a trans­plant is obviously a major event, since it is life-saving. On the other hand, the actual mechanics involved are quite minor: the infusion of several small IV bags of stem cells that were collected before the high-dose chemo­ther­apy.

When I had mine in 2007, it was customary to have trans­plants as an in-patient in an isolated trans­plant unit in the hospital. I was in the hospital for 15 days. The high-dose chemo was admin­istered on the first two days, then there was a day off, then came the trans­plant. After that, my red and white blood cell numbers were monitored as they first plummeted (the white cell number reached as close to zero as could be measured), then started back up. At that point, I was deemed safe to go home, although I was still not allowed to visit stores, restaurants, and the like until my new immune system was more “mature.”

I had been dreading the trans­plant for months beforehand. There were a couple reasons for that.

Firstly, of course, undergoing a treat­ment part of which can kill you is somewhat disconcerting, to put it mildly.

Secondly, since I had kept asking my oncologist questions about the trans­plant process, a few months after diag­nosis he gave me a binder full of trans­plant in­for­ma­tion. This ma­teri­al in­cluded a photo of someone with a Hickman port, like the one that I would be fitted with for my trans­plant. I don’t think that I was quite ready to see the several IV lines dangling out of the chest. The idea of having some­thing inserted through my skin and reaching so near my heart, particularly at a time when I would have a compromised immune system and there­fore could be sus­cep­tible to in­fec­tion, made me feel very uneasy.

In the end, though, the port (and the trans­plant as a whole) didn’t really seem too bad. Probably the least pleasant aspects were the nausea and lack of appetite. I am used to having a robust appetite, but pretty much lived off pretzels and dry cereal for a while. Of course, there are very good anti-nausea drugs which can help a lot. Unfortunately, one evening I decided that I was feeling good and didn’t need to take them. Big mistake! The next morning, a staff member came to ask what I wanted for breakfast: just hearing the words “eggs” and “bacon” set my gag reflex going. The fol­low­ing day, she barely popped her head around the door, asked “Do you want any­thing to eat?” and rushed off before waiting for a reply.

The stem cells for my trans­plant had been stored at a dif­fer­en­t hospital from the one that I was in, so I couldn’t help wondering what would hap­pen if the car transporting them was involved in an accident. It’s a bit like the scene from the Woody Allen film “Sleeper,” where they are supposed to clone The Leader from his nose, but it is accidentally run over by a steamroller first.

In my case, since enough cells had been harvested for two trans­plants, things would presumably have been alright no matter what. Not surprisingly, there was no collision, and the second set of stem cells did not have to be used. I checked last summer that these cells are still frozen and avail­able for use, in case I ever need a second trans­plant. They are.

It’s good to have options.