Stem Cell Collection

This is an Apheresis machine. I seem to have spent an awful lot of my time recently hooked up to one of these things. In order to transplant my stem cells back to me we first need to collect some, which sounds as though it ought to relatively straightforward. For many people no doubt it is...but not I'm afraid for me. The first way we attempted to do this was to use a cylcophosphamide "primer." The cunning plan here is do give the bone marrow a jolt with a rather large amount of this chemotherapy drug (or as the stem cell nurse at UCH put it "give the bone marrow a tickle!!) which has the effect of first suppressing it and then sending it into a frenzy of activity as it attempts to make up lost ground. On top of this the medics prescribe a course of G-CSF a type of growth hormone that sends production of white blood cells into the stratosphere. As there's so much of this stuff being produced there's not enough room in the marrow for it all and so some ends up in your blood stream where it can be collected by apheresis.

Well far from a tickle after I'd had the cyclophosphamide I felt as though I'd been repeatedly kicked with a pair of size 12 hobnail boots. I started to throw up during the night after the infusion and continued for the next 3 days feeling thoroughly wretched. (no pun intended!) As it was all part of a grand plan I didn't feel too depressed about it. The day of the harvest duly arrived when I was to see the fruit of all this nastiness turned into bright shiny new stem cells for the transplant. The target was 2 million cells expressing the protein CD34 (immature haematopoietic progenitor cells or blood stem cells) per kilo of body weight (I'm 90kgs!). They duly hooked me up and we waited anxiously for the result. After the big build up, the chemotherapy, sickness and general stress of the whole thing when the phone call came through from the lab it was a crushing blow. All there was in the bag was 0.1, a fraction of what was required. What's more when I returned on the day after and the one after that following more G-CSF injections they didn't even put me on the machine so few were there circulating in the blood. One of the possible reasons for this poor show is a chemotherapy drug I was given way back in 2004 called Fludarabine. If you follow the link and read down you'll see the killer phrase: "Difficulties are often encountered when harvesting peripheral blood stem cells from patients previously treated with fludarabine." No Kidding. Then to top off a really crappy few weeks my bloody hair fell out!

"Don't worry," soothed my consultant....."we have a plan."

To be continued...