Can you explain the allogeneic transplant process?

Can you explain the allergenic transplant process? So when I'm counseling a patient, I like to use the water in a bucket analogy. So if you think about leukemia like water and the bucket is your bone marrow, what we've done before a transplant with the induction chemotherapy is basically dumped the bucket out. And then we assess how much water is left in the bucket. Sometimes we can see that water in the bucket. We know we need to do a little bit more before we take a person to a transplant. Sometimes you might wipe the bucket with a washcloth. It's still a little moist so we know there's measurable residual disease there. Sometimes the bucket is dry but we know the bucket's not ready for new water. There's still some dirt or grime that needs to be cleaned out. So when a patient goes into a transplant, we provide what's called conditioning chemotherapy to prepare the bucket or prepare the bone marrow for someone else's stem cells to make a home. So that bucket has to be very clean. The conditioning chemotherapy provides that cleaning. It not only eliminates potential measurable residual disease but it also primes the immune marrow to introduce someone else's stem cells, which is extremely important for the transplant to be successful. So a patient will be in the hospital for several days receiving that chemotherapy. There are different intensities of that chemotherapy which are very important to discuss. And then after several days of chemotherapy, they might receive some radiation. That also primes the bone marrow for the introduction of new cells. And then on their day zero or their new birthday, their rebirth day, they will have an infusion of stem cells which look just like a bag of platelets. The infusion is very similar to a bag of platelets. And then following the transplant, here at Levine Cancer Institute in Atrium, we provide what's called post-transplant cyclophosphamide on the third and fourth day after transplant. This helps the immune system a bit and helps potentially prevent chronic graft-versus-host disease. So a little additional chemotherapy after the transplant. And then a patient will be in the hospital. They will expect their blood counts to go down to a nadir or down to the lowest point. We support them with blood and platelet transfusions through that process, antibiotics if infections arise. And then once their white cells or their absolute neutrophils start to increase, close to normal, that is when we let them leave the hospital. And then they come back to us very frequently for extensive follow-up, about three times a week for quite a while. And that's because in order to help these new stem cells make a happy home, we have to modulate the immune system. We have to suppress the new immune system a little bit until it's mature enough to know what to do. We use immunosuppressive therapies for that. That is because this new immune system can potentially impact the recipient. We call that graft-versus-host disease. So a donor graft, the recipient is the host. That immune system can be too intense and can impact some of the cells that are still remaining because some do hang around in the recipient. So we provide immunosuppressive therapy and we have to monitor that very closely after a transplant. So that and many other reasons, we watch people very closely after they leave the hospital from a transplant. So the whole process is extensive. The most intensive part is usually the first three months or the first 100 days. And then we still watch patients very closely for the following three months, so up to six months after the transplant. And then that's usually when things start to really settle on, normal life starts to get back in place and patients see us less.