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CHAPTER 11

“A utologous stem cell transplant?” Moran said. Sandra, seated next to him, gave the doctor a quizzical look. Dr. Kruger’s youthful face, complete with rosy cheeks, bright blue eyes and a tuft of limp blond hair that fell persistently over his right eyebrow, belied his forty-five years. Despite this, Kruger was a highly respected specialist in the field of advanced leukemia. He rested his forearms on top of his desk and laced his fingers.

“Autologous means that the donor and recipient of the transplant is the same person,” Dr. Kruger said with a mild Midwest accent. “Stem cells are immature blood cells that are removed from the blood or bone marrow of the patient. My specialty is peripheral blood stem cell harvesting, which is why rather than wait for a bone marrow donor, Dr. Cook referred you to me. It’s also less invasive.” He gazed at Sandra. “I’ve added Prednisone, Cyclophosphamide and Cytoxan to your high-dose chemotherapy treatment. Then at the appropriate time—”

Sandra looked up quickly. “Appropriate time, what exactly… I mean—” She stopped when she heard the catch in her own voice.

“We need to destroy as much of the cancer in the bone marrow as possible before we can begin to harvest. I’ve increased the chemo dosage as much as your body can tolerate in order to shorten the treatment period to three to six months… maybe shorter.”

Sandra cupped her husband’s hand and squeezed hard. It meant returning to the bouts of nausea and loss of her newly regrown hair along, with the loss of appetite that made her sick just to look at food.

“What’s involved in this harvesting?” Moran asked.

Kruger cast Moran a tolerant smile—the kind teachers give impertinent students.

“Stem cells are collected through a small catheter inserted into the patient’s vein. The number of circulating stem cells is increased in patients whose bone marrow is recovering from chemotherapy. Then by injecting Cytokines, or blood cell growth factors, we stimulate the production of immature and mature bone marrow stem cells as much as one hundredfold.”

Moran grimaced. “Have you had much success?”

Dr. Kruger gave another smile. “This procedure has been successful in forty percent of the cases it’s been used.”

“What happened to the—” Moran stopped when he realized what the answer would be.

Sandra let go of her husband’s hand and stretched forward in her chair. “What exactly are my chances?”

The doctor cleared his throat. “In order to have any shot at success we need to infuse over five million cells per kilogram of your weight over a period of nine to ten days.”

Sandra’s eyes widened.

“Since we don’t know what the minimum amount is, I like to go for the gusto.” The doctor spoke with the enthusiasm of a cheerleader. “As my son says, the whole enchilada!”

When he saw no one else shared his zeal, Dr. Kruger continued. “The great advantage of this procedure is that you will experience a faster recovery of your bone marrow compared to having undergone a traditional transplant.”

Sandra frowned. “What if you can’t collect enough stem cells?”

“Then we try again until we have enough of them. In the meantime, we freeze the ones we’ve collected. I’m not giving up, Mrs. Moran—and neither are you.”

It may have been the middle of November when Moran and Sandra walked out of Sloan-Kettering Memorial Hospital, but it felt like spring. The city was under a canvas of a cloudless blue sky and the temperature felt in the seventies; it matched their renewed hope and optimism.

Maybe Kruger was capable of hitting one over the centerfield wall.