Autumn (aka Fall) is my favourite season. It is a time of harvest and heralds the start of growth anew. So, with a few days off between cancer treatments, Nagib and I took off to Niagara to enjoy the Fall scenery.
As the leaves begin to change colour and farmers’ markets fill with barrels of apples, tomatoes and red-hot chili peppers, I am going through a transformation of my own — I am beginning the process for the mobilization (i.e. getting together), collection (harvest) and reinfusion (transplant) of my stem cells.
So, what are stem cells anyway? Stem cells are thought to be the origin of all blood cells. They live in the bone marrow, and are capable of reproducing themselves and producing red and white blood cells as well as the platelets that make up the components of blood.
After having gone through eight weekly treatments of chemotherapy (CyBorD) for the Multiple Myeloma, I’m ready for my transformation.
Stem Cell Mobilization
Today, Monday, October 1st, I was given an aggressive dose of cyclophosphamide – four times the strength of the chemotherapy treatments I have been getting so far. I have been told that I will be very sick from this chemo for a few days, and I have been given preventative medicine to help me cope. Later this week, I will be receiving daily injections of Neupogen that stimulates the bone marrow to produce more stem cells and release them into the bloodstream.
The Collection Procedure
Stem cell collection is scheduled to take place starting next Tuesday, October 9th. This is a fascinating process. First, a simple blood test determines whether there are enough stem cells circulating in the bloodstream. We are looking for 2 million stem cells per Kg of weight. (You do the math!). If there are not enough stem cells, I go home and continue the Neupogen injections and keep coming back to the hospital every day until there are enough stem cells to harvest.
The stem cells are collected through a “Quinton” line. A Quinton line is a plastic tube which is surgically inserted into a large vein in the neck. (Oh no, another poke!). The technique for collecting stem cells from the bloodstream is known as “apheresis”. A cell separator device (the apheresis machine) is used to collect blood through the Quinton line, separate the stem cells and return the remaining blood back into the body through my existing PICC line (which is in my left forearm).
Each session takes approximately four to five hours, and may be repeated for two to five days until enough stem cells are collected for two transplants. (I’m told they will be collecting 200 million of these little guys). At this point, the Quinton line is removed and I go home to wait. The stem cells, light pink in colour, are frozen until it is time to transplant them into my body.
As there are only a limited number of transplant beds available in hospital, and there are many patients awaiting stem cell or bone marrow transplants, I may have to wait for up to two months.
In the meantime, I may begin a third cycle of weekly chemotherapy treatments (each cycle is four weeks) and I will undergo a battery of tests: Dental exam (by oncology dental specialists at PMH), Pulmonary Function Test (to assess the functioning of my lungs), MUGA Scan (X-rays of the heart) and Echocardiogram (ultrasound of the heart). All of these tests are to ensure that my organs are functioning well, and to provide a baseline for comparing any changes that may occur after the transplant.
On October 22nd, I’m scheduled for a minor surgical procedure to insert a Hickman line (a double-lumen catheter) which is inserted into a large vein in the chest, below the collarbone. It is the most secure method to administer chemotherapy, draw blood tests and to reinfuse the stem cells. My PICC line, which has served me faithfully for four months, through thick and thin, at home and on vacation, in and out of water, will be removed at this time.
The Transplantation process
The transplantation process begins with admission into Princess Margaret Hospital, as soon as I get “the call”. On day 1, a high dose of Melphalan (another more powerful chemotherapy drug) is infused. The purpose of this chemotherapy is to wipe out all of the red and white blood cells and platelets in my bone marrow. On day 2, the transplant doctor brings back my frozen stem cells and thaws them in a warm water bath! Once thawed, the stems are reinfused through my Hickman Line, similar to a blood transfusion.
I’m told that the thawed blood will cause me to smell like corn for 24 to 48 hours! Another reference to the Fall season (LOL). This is because the chemical used to preserve and protect my cells during the freezing process (dimethylsulfoxide) smells like corn. Thank Goodness! It could have smelled like Hydrogen Sulfide (get it?).
Then it’s up to my transplanted stem cells to engraft (begin to grow and produce new cancer-free cells). This entire process will require me to stay in hospital for up to 3 weeks (thankfully not in isolation most of the time), during which my low blood counts may require additional blood transfusions.
By December, I look forward to coming back home transformed into a new – albeit tired – Munira, all bundled up and ready to tackle the cold and snow of the winter season!