Monday, August 15, 2011

Autologous Stem Cell Transplant

Autologous Stem Cell Transplant Used in the Treatment of Multiple Myeloma

The greatest current treatment for multiple myeloma is known as the "Arkansas Treatment" -- which includes numerous cycles of chemo, lots of different cancer-fighting drugs, and an autologous stem cell transplant. in fact, it calls for two stem cell transplants in a row, known as a "tandem" transplant, but the early chemo cycles damaged the author's heart muscle so he only fit for the first transplant. This chemotherapy regimen carries the name Arkansas Treatment for the reason that the doctor who developed it lives and practices in Arkansas.

When the author asked the question, "Why two transplants?"
the answer given was that some of the cancer cells hide and are hard to find. So if the first transplant works well, the second should take care of any and all remaining cancerous cells. When they collected the stem cells, their goal was to collect 10 million. They return about 5 million to the patient during each transplant.)

The first few days of this cycle were the easiest. Once again, the author moved into a hotel room within a mile of the cancer clinic for the duration of this procedure. The first two mornings at the clinic were the days they administered the "high dose" drug. This particular drug is one that directly attacks and kills all cancer cells. Most of the other drugs used in earlier cycles of chemo worked in indirect ways to attack the cancer. This drug has been around for years and it goes directly after the cancer cells.

Actually, this drug has a broader effect than just attacking cancer cells. It attacks all fast-reproducing cells in the body which includes, of course, the cancerous cells, but also includes hair follicles, skin, and many good blood cells. They call it a "high dose" step because they give the patient sufficient drug to kill all targets. Some of this drug was administered Monday morning, and the rest was administered Tuesday morning. Both were relaxed days. The infusions didn't take very long and the author was quickly released to return to his hotel room. On Wednesday, they infused a bag of saline, but nothing else. That, too went quickly, and the author was once again sent back to his hotel room.

Thursday was designated day "0" because it was the day the stem cells were reinfused into his body. They described this day as the "first day" of the author's "new life." The stem cell infusion went easily and quickly, as well. And once again, the author returned to his hotel room. Each of the following days called for the author to return to the clinic to have his blood counts checked. Any minerals needed in the blood could be infused, but generally, most of those days were short stops at the clinic.

The reasoning behind the transplant procedure appears to be this: Since they collected the patient's stem cells at an earlier date and they were safely in storage, the high dose drug could not affect them in any way. So they conveniently missed the effects of the high dose meds. When they were once again returned to the patient on the Thursday of that week, the high dose drug in the patient's system was no longer effective, so it could not cause any harm to the newly infused stem cells. Following reinfusion of the stem cells, all that was left to do was wait. The staff explained that it would take 9 to 11 days for the stem cells to locate properly and to begin working again. At that point, blood counts would once again begin to rise.

The author remembers that following the reinfusion of his stem cells, he felt fine. His blood counts were still relatively high and he was told he didn't need to stay isolated in his hotel room.

It was only that Sunday and Monday that the blood counts dropped off precipitously and he had to hide away in his hotel room. This drop in blood counts came from the effects of the high dose drug. In addition to the precipitous drop in blood counts, the author's energy dropped off precipitously as well. To rearrange his position on the bed, from lying there propped up by a pillow, to move slightly and fluff up the pillow, was a real chore. Walking from the bed to the bathroom was quite difficult. During this time, they had connected a portable pump and large bags of saline to the PICC line in the author's arm. A second portable pump, connected to the second lumen on the PICC line maintained a very slow flow of an anti-nausea drug. If needed, the author could push a button on that pump and it would dispense a much more substantial volume of the drug directly into the blood stream where it could do its thing. No trying to take pills and hoping they would stay down long enough to become effective.

This system was great! Even though the author really didn't need to use the anti-nausea meds, it provided peace of mind because the author knew that if needed to press the button, it would deposit the meds right into his blood stream where they would do their thing! Press the button, and -- instant relief. The most difficult part of this process was getting up the energy to pick up the bag holding the pumps and fluids and carrying it to the bathroom. The fact that saline was being pumped into the patient 24/7 during those days forced frequent visits to the bathroom -- whether he could muster the energy to do it or not!

During those days, his white blood cell counts were near zero. Normal values are in the thousands. During that time, the sheet showed values of 100 -- which means that values around 50 would have been rounded up to produce the 100s shown on the CBC sheets. The oncologist had predicted at the start of chemo that the author would probably not get sick (meaning nauseous) during the process of chemo. The only thing he predicted was that the author's energy would be extremely low. The lowest energy days of the whole six months of chemotherapy treatments were during the week following the administration of the high dose drug and the reinfusion of the stem cells.

The transplant nurses all said that the blood counts would begin to rise once again, due to the functioning of the new stem cells, about the second weekend (days #9-11 according to the new count.) That prediction too was accurate. Sunday's test results indicated the blood counts were about to rise, and Monday's results had them sufficiently high that the author was released from the hotel room and allowed to go home.

During the time when blood counts were particularly low, they were very careful to monitor body temperatures which could have indicated an infection of some sort. The stem cells themselves, as they positioned themselves back in the bone marrow cavities of the bones, could cause slight temperature rises. But during the evenings in the hotel room when body temperatures rose a little, taking over-the-counter anti-inflammatories were sufficient to cause the author's body temperature to drop back into the normal range. Had the body temperature risen and stayed high, they were prepared to admit the author to the transplant ward of the hospital as an inpatient. That didn't happen though. This whole procedure was performed as an outpatient procedure. A week's stay at a nearby hotel was much less expensive than a single day as an inpatient at the hospital.

Having gone through this autologous stem cell transplant, the only good reason for not wanting to do the second was that it meant the author would lose his hair again (... and that wasn't a very good reason.) The echo-cardiogram results proved the undoing of the second transplant. The author's heart function had deteriorated throughout the chemotherapy sessions to the point where his "left ventricular ejection fraction" (the efficiency of the heart) had dropped well below normal. The author is now seeing a cardiologist and taking pills for the treatment of congenital heart failure, but he is alive and functioning relatively normally on most other fronts.

Energy levels today are not as high as they once were, but the author can still be active and participate in normal activities (albeit very slowly). Sometimes unusual things happened -- for example, it is now easy to fall asleep while typing at the computer -- which never happened before. Standing in one spot for long periods of time is difficult. It is easier to walk slowly, than to stand still. When necessary, the author uses a wheelchair, but most of the time a cane suffices.

The result of the whole chemotherapy process, including four cycles followed by the high dose/stem cell transplant procedure is this: the author is currently "as clean of the cancer as he can be," according to the oncologist. Next week will be the two year anniversary of the stem cell transplant. It has been a successful procedure. Not all cancers can be treated with stem cell transplants, but this one -- multiple myeloma -- can. If other multiple myeloma patients are reading this article, please note that the author's overall experience with this treatment process has been a good one!

Autologous Stem Cell Transplant Used in the Treatment of Multiple Myeloma

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