WFH With Cancer — Stem Cell Harvesting
I wanted to discuss my experience around the Stem Cell Harvesting that I did in December 2021. Stem Cells are the bodies raw materials and building blocks to generating other cells within your body. Stem cells are blood cells that are at the earliest stage of their development. They are found in your bone marrow, which is a spongy tissue found within bone, in particular your hip bones. Bone marrow makes all of your body’s blood cells. These are collected in order to help your body regenerate cells when you go though high dose chemotherapy, as your stem cells are destroyed and the collected stem cells are given back to you during the Stem Cell Transplant to help your system reset.
Not everyone undergoing treatment for myeloma will have a stem cell harvest and transplant. Age is a high factor in determining if you are suitable, as is your health, type of cancer too. But there are possibilities for a stem cell donor to step in too should you not be able to harvest, or if your counts after harvesting are not suitable for transplanting.
The Stem Cell Harvest itself is a 6 to 8 hour procedure, but there is a 7 to 10 day lead up to it which I will be discussing in this podcast. On Monday 6th December I started my Stem Cell harvest at 7:30am with blood tests and general BP, pulse and temperature checks. After that I was brought into the day ward and settled down for a day of sitting around with an IV attached to me. I was given a 2 hour infusion of a rehydration fluid (sodium chloride), followed by a 2 hour infusion of a chemotherapy drug called Cyclophosphamide, followed by another 2 hours of rehydration fluids. 6 hours in total of being attached to an IV. During that time you are given fluids, anti-nausea tablets, and are allowed to walk around (you just need to bring the IV with you). You are also given sandwiches, and tea or coffee. During the day your BP, pulse and Temperature is monitored at regular intervals, and at the end of the day they repeat the bloods too.
Its a long time to be in the chair if you are not already used to it, so its recommended that you bring a book, or a tablet with some movies or tv shows on it. I managed to watch 2 movies and also listen to some podcasts while I was having my treatment.
At 6pm I was able to go home, so it’s a long day and while you are just sitting around for it, its also very tiring on your body so I went to bed early that evening.
Overnight I was very sick from the treatment. I was up every 30 minutes, and was not able to do much the following morning. I have been prescribed motillium tablets for the sickness, but they were ineffective. I called the hospital the following morning and they sent a prescription to my chemist for Ondansetron which is a stronger anti-sickness tablet which I took for 7 days. This helped a lot.
On Tuesday afternoon I also started taking 2 daily injections of Neupogen which is used to regenerate your stem cells. This actually causes an over production of stem cells which is then captured in the harvest itself. These were taken at 5:30pm each evening after being taken out of the fridge an hour before hand. Thankfully my wife Kim was happy to administer these into my stomach. I also started doing regular mouth washes. This is because the combination of the chemotherapy drugs and the injections can cause ulcers and infections in your mouth.
I was also still quite tired so had another early night, and while I was working Wednesday, I felt I needed to nap that afternoon too.
Thursday I was back to my normal self, and on Friday I was in the hospital for blood tests, and the usual BP, pulse and temperature checks. They are looking for an increase in the white blood count to show that the stem cells are ready for harvesting which can occur between days 7 and 10, but honestly, as they told me that I would experience back pain when that was the case, I knew that it was not harvest time yet. They also were looking for increase in temperature as that could show an infection.
The weekend was injections as usual, and continued to take the mouth washes.
Monday morning I was back to the hospital for bloods and then I got a call from the hospital in the afternoon to say that I was ready for the harvesting. The back pain had also started to I took paracetamol to help with that as recommended. I would need to be in the hospital Tuesday morning at 7:30 and would need to bring an overnight bag with me too. I was also told that I should start taking the antibiotics that I was prescribed to ward off infections.
Tuesday I was up early and had a recommended milky breakfast. Calcium was needed for the day. I was at the hospital at 7:30 again and fast tracked into the day ward where bloods, blood pressure etc were all taken early. I was then brought down to the radiology department as I was to get a VASCATH fitted through which they would harvest the stem cells, and also give me any IV drugs needed during the day. Usually the harvest is done via 2 cannulas into your arms (one in each into the crook of your arm) but due to the injury in my left arm they would use a VASCATH instead as I would not be able to hold my arm in that position for the few hours needed. This meant that I was able to use my arms during the day which would be a lot handier, but meant that I would be admitted overnight as the VASCATH could not come out until the stem cells were tested and counted after the harvest.
The VASCATH procedure was 30 minutes in total and done under a local anesthetic. A VASCATH is a catheter (flexible plastic tube) that is inserted into a vein located in the neck. They have 2 or 3 tubes called lumens at the end of them allowing bloods to be taken, but also fluids to be inserted. Its done via CT Scan and being December the surgeon performing the procedure wanted to listen to Christmas music during it. He talked me though everything that was to be done, and when he pulled up my xray on my arm said that he had done the post-op notes on me when I had my operation back in June.
At 10am I was attached to the harvester and the process was started. I was given a calcium drink to take and then the machine started working its magic until 5pm that evening. The machine is a centrifuge that takes blood from you, and then over the course of the hour spins the blood to release the stems cells and plasma which is collected, and then the blood is returned to your body. The process is then repeated, with the machine separating the blood and cells every hour. The machine itself sounds like a washing machine on a spin cycle for about 10 minutes each hour, and apart from that its not very noisy.
It’s a very tiring process and you cannot be removed from the machine until it is completed. They monitor your BP etc during the day, and will also give you calcium infusions should you need it. You are in a reclining chair so nap when you can and you will not have much of an appetite during the day. I found that it was very tiring sitting there all day and while I had downloaded a few movies to watch I did not have much concentration.
You are in a room with 1 other patient, and 2 nursing staff all day, so its quiet enough. Other staff will come in from time to time but apart from that you are isolated from what’s going on outside. While I was in for the day, the other chair had 2 patients in during the day. One in the morning to get more stem cells out, and the other in the afternoon being given a treatment that required use of the stem cell machine.
At 5pm I was removed from the machine and a tech from the cryonics department arrived to take the plasma and stem cells away to testing and storage. The stem cells are sampled to check counts as should there not be enough they will reattach you to the machine the following morning to get more cells. This was also the 1st time I had to stand in a few hours and felt a bit dizzy. They do say not to drive on the day of the harvest and thankfully my brother had driven me in earlier that morning, and would be collecting me when I was discharged.
At 7pm I was admitted to the ward, and 9pm was informed that the stem cell counts were perfect and that the VASCATH could be removed and I was free to go home. Removing the VASCATH is a 30 second procedure. You are basically told to hold your nose and blow out your ears like you would when landing in an aircraft. While you do that they pull the tubing from you. I was then to lay down for 15 minutes before I was allowed to leave, and at 9:30 my brother collected me from the main entrance. I was to continue to use the mouth washes and was also told to take potassium tablets for a few days.
The following morning I was really tired so slept in and returned to work in the afternoon. On Thursday I was in for my regular monthly bone strengthener and nebulizer and was also informed of the counts and told that the cells were all perfect and in cold storage now waiting for the transplant. My bloods had returned to normal and I was not in any pain. They also did an updated paraprotein level check and that showed as 1.1 which was down from the last time which was brilliant and heading in the right direction. The tiredness had also stopped so I was back working regular hours too.
As for side-effects, apart from the nausea and vomiting from the chemo on the 1st day, and tiredness for a few days, there was not much regarding side effects for a few weeks. On Christmas eve however, 2 ½ weeks after the chemo I noticed that my hair was starting to fall out. This got worse the next few days, and while not all the hair on my head fell out, I got a haircut on the following Wednesday when the barbers reopened. This is a common side-effect of the chemo, but talking to others that have been though the stem cell harvesting, not everyone looses their hair. For the moment I am embracing the short hair and wearing hats when out due to the cold weather, but know that the hair will regrow but I will loose it again in a few months when I do the transplant.
So that was the end of the harvesting, and while I know I will be getting the transplant sometime in February, I don’t have a starting date for it at the moment, but at least with the chemo side, I know what to expect during the start of that treatment.
Early December I also had a follow up with the surgeon in relation to my arm. Xray’s again showed a huge improvement and he was happy with the mobility of the arm. I was able to raise it to 90 degrees to the side and out front, and was told to keep up the physio exercises. I was also told that my next check would be in 6 months.
Its been just over 6 months now since my 1st diagnosis and while that is a long time, the speed in which my treatment has progressed, and the recovery on the arm has progressed too is brilliant. They say that for myeloma you are in treatment for a year from start to finish, we are getting to the end of the treatment cycle now and I can see positive conclusion coming soon.
