What exactly does this big stem cell transplant entail? It took me numerous consultations with multiple doctors to really get my head around it. When I write about it here, I tend to distill it down to a few lines…but judging by some interactions that I’ve had recently, there are lots of misconceptions about the master plan. Which is fine. You all out in blog-reading land don’t need to be obsessing about the finer points.
But maybe you want to obsess. And I want to lay it out for a couple of people who claim to be interested, so, dear reader, here it is, with the caveat that it has been YEARS since I’ve taken cell biology and accordingly may not have it 100% right.
First…a stem cell is found in the bone marrow (amongst other places) and has the ability to become one of many cell types depending on the signals it receives. For example, the stem cells that I will receive will (hopefully) turn into various parts of the immune response: white blood cells, B cells, T cells, as well as repair the bone marrow damaged by chemo.
May 30-31st: I begin GCSF injections. I’ll be getting Neupogen, one of several GCSFs that revolutionized blood cancer transplants when they hit the market. Neupogen will stimulate stem cell production in my bone marrow, producing massive excesses of stem cells. The huge volume of cells won’t fit in my bone cavities, so the stem cells will work their way out of the marrow, into my blood stream. This is revolutionary because without the GCSF, doctors would have to harvest stem cells directly from the marrow, which involves lots of drilling into the bone, lots of infection risk, and lots of pain. But with this drug, we’ll harvest stem cells from my blood stream.
June 1: GCSF injections, then over to Inova Fairfax for catheter placement, aka surgically-implanted bling. It is all the rage in Europe. I’ll get two this time, both in my upper chest. One is called a Quinton, and it is a heavy duty catheter for stem cell harvest. In this picture, everything north of the little nub will be hanging out of me, with the long straight tube implanted in my vein. The second one is a Trilumen, which basically looks the same but has 3 access ports. It is a little less heavy-duty than the Quinton.
June 2-5: Harvest! Sounds so pleasant, so pastoral…and yet. Turns out that apheresis, while preferable to bone marrow harvest, is still a bit of a drag. My entire blood supply will circulate through a big machine, which will extract the stem cells while letting all of the other blood cells pass through. And I will be hooked up to this machine for 3 or 4 days, from 8 am-4pm. I get to use a bedpan, even, so that I can stay on the machine. Good times. Note to visitors: please don’t be bringing me no drinks or high-fiber snacks. Every night, they’ll calculate how many cells they collected and freeze them down with DMSO, a preservative. By the end of the week, I need to have roughly 5 million healthy stem cells bagged up.
June 8-14th: High-dose chemo. This chemo cocktail is designed to annihilate any remaining cancer cells lurking in the depths of my lymphatic system, and keep me from having another relapse. It is actually the “cure” in the whole transplant process (which is different than leukemia patients who have a transplant; for them, the new stem cells are a cure in and of themselves. Sort of .) but there is substantial collateral damage. After this chemo, my bone marrow will be so damaged that it cannot produce an immune response, and I would likely die of some secondary infection without the transplant.
The chemo is rough, but the word on the street is that if I can handle R-ICE, I can handle this; the effect on the body is more profound, but the side effects are similar. They do send me home at night with a fanny-pack I.V. pump (to complete the look, you know) full of anti-nausea drugs to keep the good times rolling.
June 15th: Transplant day! And yet, pretty anticlimactic. I get an IV infusion of those healthy cells I froze down. Apparently, this makes me smell funny for a couple of days, from the DMSO working its way out of my pores. Everyone I talk to mentions this, so I guess it is pretty pronounced, although there is no consensus as to what the smell is: strawberries, bananas, creamed corn. Could be worse.
June 16-26: Waiting. The chemo will continue to make my blood counts drop, ultimately to zero for most cell types. I’ll be profoundly tired and still weathering the chemo side effects. I’ll spend all day, every day, at the clinic, getting monitored, receiving blood and platelets as needed, napping, and watching Hulu. I do go home at night, but there will strict infection controls in place at home.
June 26ish: Engraftment. The healthy cells make their way into the marrow, and start repairing the damage. Slowly my counts should improve.
June 27-July 15: Baby steps up the hill to normalcy. Hopefully, by mid-July, I’ll be down to weekly visits to the clinic, and starting to get back to my regularly scheduled life. I’ve talked to a lot of people who have undergone SCTs at this point, and most say that they still feel pretty tired a month or two out, but that by 6 months or so, they were really feeling great.
So there you have it. Way more than most of you ever wanted to know about all of this…
Take care, everyone.