Stem Cell Collection - Part One

So, in order for a blood and marrow cancer patient to have a stem cell transplant, the stem cells have to be collected from the patient or from someone else. In the case of an autologous transplant, they're collected from the patient (see me raising my hand for the purpose of identification). While only 3 to 5 million stem cells are required for the transplant, my doctors wanted to play it safe and collect between 10 and 15 million cells, enough for a few autologous transplants. In order to be fully prepared for the transplant and all that goes with it and follows it, the patient also needs to have a "central line" put into his or her chest. So, here's what the past week has been like for me...

Friday, February 1
At about 8:00 a.m., I got out of the shower and felt a mild twinge of pain in my lower back. It lasted about 5 or 10 seconds then went away. I said something like, "What the heck?", and then I forgot about it.

At 9:00 a.m., I received my first injections of Neupogen, a drug designed to cause the stem cells in a person's body to proliferate, or reproduce faster than normal. The most common side effects are mild flu-like symptoms and bone pain. The bone pain is caused by the marrow in the bones working extra hard to produce the extra stem cells.

During my day at work, my lower back pain came and went, but every time it came, it lasted longer and became more severe. I tried to stretch it out, as one would typically do with back pain, but it didn't help. By the time I got home, the back pain was almost unbearable, and there was nothing Noelle or I could do to determine its cause or find a position for my body that relieved it. While it continued to come and go, additional pain began in my sternum. I called and spoke with the charge nurse at the hospital, and we determined that with the pain beginning before even starting the Neupogen that morning, the two were not related. She told me that if the pain was still there in the morning, I should come in to see if we could determine its cause and find a good treatment for it.

Saturday, February 2
After a fitful night of "sleep," I gave up on the idea at about 6:30 a.m. I called the BMT Clinic around 8:00 and was given an appointment at 10:30. By this point, the bone pain from the Neupogen had begun in my pelvis and hips, adding to the discomfort in my back and sternum. In order to give Shar, the PA we met with, as accurate a description of the pain and its whereabouts, I didn't take any Oxycodone or any other pain killer that morning, though I really, really wanted to. Unfortunately, Shar couldn't figure out the cause of the pain in my back, though she did let me know that the pain in my sternum was related to the Neupogen, and not to the back pain. After three hours of attempting to figure out what was giving me the back pain with blood work, tests and medication, Shar ultimately gave up and prescribed a stronger pain med (Oxycontin) than the Oxycodone I had and said it should help with my back pain as well as the bone pain from the Neupogen. The Oxycontin helped a lot and by Sunday the mysterious back pain went away and I was left only with the bone pain from the Neupogen.

Sunday, February 3
Bone pain, bone pain, bone pain. I walked around like an old man on Sunday, as I was really feeling it in my hips. Although they made the second half interesting, my 49ers lost the Super Bowl to the Ravens, who looked like the team of destiny all through the playoffs. That's about all I have to say about Sunday.

Monday, February 4
Monday was the day to remove the "peripheral" or "PICC" line from my arm and replace it with the central line in my chest. I came to the hospital at 7:15, having not eaten since Sunday evening, as they had requested that I come fasting since midnight with the exception of water to take my pills. No problem. The surgery was scheduled for 8 a.m., and would only last about 30 to 45 minutes under conscious sedation. Then after a little time in recovery, I should be able to eat and go home. After drawing some blood work on East Eight, Noelle and I went down to the Angio Prep/Recovery room. My surgery was delayed for about 3 hours because there was an emergency with another patient that took doctors away from my unit, as I understand. I hope that whoever it was is OK and recovering well.

Here's a picture of me waiting to go in for my surgery.

So, finally, a few minutes before 11:00, I was finally taken into the operating room, given some "happy juice" through my PICC line and the next thing I knew, the operation was over, and they were pulling the PICC line out of my arm and dropping it in a trash can. When I got into recovery, Noelle told me that East Eight called down and said that my labs came back and my numbers looked so good that they wanted to begin stem cell collection that day...as soon as we could get back up to the BMT Clinic.

So, up we go to get me hooked up to the apheresis machine. For about three hours, blood flowed out of my body and into the machine. It spun and separated my blood, pulled out the stem cells, and then returned the rest of my blood to my body. We cycled through 15 liters of my blood in those three hours, hoping to get a few million stem cells out of it. That would get us off to a good start before even receiving my first injection of Mozobil, which is the drug designed to cause the newly generated stem cells to be released from my marrow into my blood stream. Well, obviously the Neupogen had caused so many stem cells to be generated that a lot had already released into my blood stream with nowhere left to go inside the bones, as indicated by the 5.04 million stem cells we ended up collecting on Monday. It took a while for the count to come back from the Red Cross labs, and we had to wait for the number before I received my Mozobil injection. Obviously, if we had somehow collected over 10 million stem cells Monday, I wouldn't need the injection. Though it was a long shot, we had to wait. Then after receiving my shot, they still had to "observe" me for 1/2 an hour to ensure I didn't have an adverse reaction to it. I finally left the hospital around 9:15 p.m., 14 hours after getting there and 10 hours before I had to be back in the morning.

Stay tuned for the exciting conclusion of the story. (That means this post is long enough already and I'm too tired to write any more.)