Monday, July 27, 2009

Myeloma transplant - Stem cell collection

Before my transplant could commence I had to have my own stem cell collected/harvested.
Stem cells normally live in the bone marrow. They can be encouraged to move out of the bone marrow and into the blood stream from where they can be collected. This process is called “stem cell mobilization” and usually involves the use of stem cell growth factors (e.g. G-CFS) in combination with chemotherapy.
[Source NZ Leukaemia and Blood foundation]
To commence the process I was given chemotherapy (cyclophosphamide) which gave me the normal nausea for a few days.
This was followed 5 days later by G-CSF daily injections by Myra to stimulate the stem cells to multiply eventually moving out of the bone marrow into the blood stream for collection. [Peripheral blood stem cell mobilization and collection]. Daily blood tests were now required to find the optimum time for stem cell collection.
An apheresis line [Central vein catheter in chest wall] was inserted into my chest for stem cell collection and also used during my ASCT. My catheter was inserted into a large vein in my chest then travelled down the vein into the top of my heart. It had 2 lumens (thin plastic tubes) an inlet and outlet. The nurses flushed my lumens and changed the dressings regularly to prevent infection. It was used during ASCT for fluids, chemotherapy, antibiotics and other drugs, blood and platelet transfusions, stem cell infusion. My veins are thin and hard to find so it was a relief to know all was being done down the central line eliminating the need for constant needles.
During the night before my stem cell harvest I experienced the most intense pain I have ever felt. Commencing about 1.00 am the pain was in my pelvis, top of legs and lower back. So intense I could not lie in bed or sit, only stand rigid unable to move. It bought me to a standstill for 30 minutes eventually disappearing after an hour. Myra phoned the hospital who advised panadol or morphine. This had no effect.
I have since read that Neupogen used to mobilize the stem cells usually causes mild to severe bone pain as the marrow goes into overdrive producing more blood and stem cells. This would have been the intense pain I experienced.
If you are reading this and about to have a peripheral blood stem cell mobilization and collection, please discuss the possibility of mobilisation pain and how to control it with your medical team. It slipped under my radar causing me great distress.
The following day after daily blood tests the hospital phoned and said the time was right for my day one of two stem cell harvests. All went well, no dramas. It took four hours, left me feeling tired, I was in bed asleep at 8.00 pm. Overnight I experienced more intense pain but not as intense as the first night. Next day was day two of stem cell harvest, again no dramas. Over the two days there were enough stem cells collected for two transplants. These were taken away for tests and to put in frozen storage.
Two days after the second stem cell collection I suffered blurred vision in my right eye resulting in a retina vein inclusion explained in the next posting.

This is one of “part 2” a series of postings relating to my autologous stem cell transplant for myeloma. As they are complete the posting series can be found under labels/part 2 [Here.]

ASCT: Autologous stem cell transplant.
G-CSF: granulocyte – colony stimulating factor.


Sandy said...

Sid -- I think that letting people know about the potential challenges ahead of time is a great effort on your part... minimizing the additional surprises brought on by the biggest one of all. Hats off to you for preparing this blog.

Sid said...

Thanks Sandy,
One of my lifes aspirations: People helping people.

Susie Hemingway said...

I agree entirely with Sandys comments...every little bit of knowledge gained on all aspects of MM can only do good. Your postings are clear, precise and most helpful.
Thank you for this, we send all best wishes for your continued health from us here in the UK.
Susie Hemingway Moursi and Hamada Moursi