Sunday, July 7, 2013

What's a stem cell transplant?

Over the past few days, several people have asked me what a stem cell transplant is. Since probably few of you out there know, I'll take this opportunity to educate.

There are two types of stem cell transplants: 1) auto (where you get your own stem cells back); 2) allo (when you get a donor's cells). For MM, auto is the preferred choice. For one, it's effective and second, there are no chances of graft-host issues. 

For me, I had two stem cell transplants, which the medical community calls "tandem", which means you get two transplants within a six month period.

Step 1: Install a port
A port is installed in the chest area that makes administering chemo drugs and drawing blood work easier. From that port in the chest runs a line up to the jugular vein. I still have my port in. It's not very pretty but it doesn't bother me. I was put under anesthesia when it was placed in my chest.

Step 2: Chemo 
The first step is a big huge dose of chemo to kill off as many cancer cells as possible. I carried a backpack with me for four days, which gave me a continual 24-hour non-stop chemo stream. Side effects include: chemo brain, fatigue, nauseau, diarrhea, constipation, food aversions, infections, and bruising. During this time, I got regular blood work to ensure I wasn't too anemic. As it turns out, I did get "that" anemic and was nearly hospitalized for it. Luckily for me, I didn't get sick to my stomach, though I did crave pickles like my ex husband Bob craves alcohol. I would shake and panic until I could get to the pickles. Weird. And I hated apples but loved lemons. Go figure. I did this regimen twice. The first time, I was very cranky. I felt like everything smelled like chemo-- my skin, taste buds, hair, pee... The second time, I pulled out a very cute bag I purchased a few years prior at Saks, put the ugly chemo black backpack inside of it, and carried on. About a week after the chemo is done, my body had no immune system. I had less than 1 white blood cells and red blood cells. This means I had to be in a "clean" apartment less than six minutes to the hospital in case I ran an infection. As it turns out, I did run an infection and was hospitalized for four days. This is also the time in which my alcoholic husband was texting me that I was a liar and thief. It was not a good time.

Step 3: Install pick line
A pick line was installed in my neck. This was necessary in order to harvest my stem cells when the time was right. It was incredibly uncomfortable and mine was in my neck for a week. I thought I was going to lose my mind. It was horrible.

Step 4: Harvest stem cells
Harvesting my stem cells involved getting hooked to a large, loud vibrating machine for several hours while my blood went through a machine (similar to dialysis), took out the stem cells, then put my blood back in me. It wasn't painful and I slept. I was exhausted for days after harvest.

Step 5: More chemo
For about an hour, I chomped on ice chips while heavy-duty chemo was administered into my veins. 

Step 6: Stem cells replacement
Two days after chemo, I was given back my own stem cells.

Step 7: No immune system
These are the toughest days of the whole procedure. After I got my own stem cells back, it becomes a waiting game on when the immune system comes back and when the stem cells have engrafted. During those days (about 10 total), I felt like hell. Mental and physical fatigue are horrible. And because I had no immune system, I had to sit in a hotel room watching non-stop TV and eating processed foods (nothing fresh because I could get a food-born illness). I couldn't be home, I couldn't be around my children, I couldn't do anything (not that I wanted to anyway).

Step 8: Engraftment
Once the blood work shows that there are at least 7 white blood cells, that means the body has accepted the stem cells and are reproducing and it's time to go home. 

Step 9: Recovery
For about a month post transplant, walking up stairs left me dizzy, heart racing, and buzzing. It was a slow, tough recovery process. Thinking made me tired. I had to concentrate to do anything. 

And that's what a stem cell transplant is in a nutshell.