The Stem Cell Transplant Process

I realized that I haven't really described what I am doing in New York, the treatment. I will try to be brief, it is kind of an amazing process.

I am doing a stem cell transplant because normal chemo has proven not to work. The proof is that my cancer has come back again. Our doctor at University of Colorado Hospital referred us to Sloan Kettering in NYC. We visited this doctor back in June of 2009 to consult with him about a stem cell transplant because we weren't sure if the chemo over the summer would work or not (it did, but only put me in remission for 4 months)

The Stem Cell Transplant Process

(Part A is done once, Part B is done 3x)

Part A - the extraction of the stem cells ("low dose chemo")

This is called "low dose" chemo because the other part is high dose. The dose is actually the same as normal chemo. They are generating MY stem cells for transplant, an autologous transplant, this means I do not have a donor. They can use my cells because the disease is not in my bones/blood. For 3 days I am given 2 chemo drugs, then would be sent home. For the next 8 days I take a shot to stimulate stem cell growth. The purpose of the chemo is to deplete the bone marrow enough so it knows to generate new stem cells, the shots help the body produce a lot of them.

On Day 9, I am hooked up to a machine which filters the stem cells out of my blood. This is similar to dialysis. They are trying to remove 8 million stem cells to be used for part B of the treatment. On days 9-12, they try the process to get a total of 8 million cells. It took me 2 days and they got 11.2 million cells! (the doctors were impressed because I had radiation, which makes this process more difficult)

Part B - high dose chemo/stem cell transplant

High dose chemo happens for 3 days, then one day of rest, then they infuse the stem cells in me with a syringe. They infuse 2 million back into me on each cycle. There are 3 cycles of the high dose chemo. The reason they needed 8 million is in case something happened to one of the "packets" - this is a backup. Since I generated more, he has additional backups, which we don't expect will be needed. In between the high dose chemo, there is 3 weeks minimum between the first day of chemo and the start of the next cycle.

At this point, I have completed part A. I have completed the first of 3 cycles for part B. The first cycle didn't go very smoothly. I was out of the hospital for only 4 hours before having to go back because I was in my "nadir" very quickly (I was in the hospital for 18 days total not counting the 4 hour break). This is when all of my blood counts start going down and is what happens with chemo, which is why the stem cells are important, they help my body generate the blood/cells that it needs to keep my immune system fighting. The nadir period usually lasts from day 7-14 (in the 21 day cycle). The difference between chemo and high dose chemo is that the nadir period is not as predictable. High dose chemo is likely to put you in the nadir period for much longer, which is why the stem cells are important for that cell generation. During this time I am expected to feel like crap and also be exhausted while my body works so hard to give me back the cells that were stripped from me during chemo.

Clear as mud?