High Dose Treatment with Stem Cell Support

Its been a while since I wrote anything here but I’ve been to a meeting at the Freeman hospital today to discuss my next steps so thought it was time for an update. Its been a while since I bored you with my posts so this will be a long one…sorry. 🙂

Last week I had my regular break from treatment having completed cycle 5. I met with my consultant on Tuesday of this week to discuss the next steps. He asked me if I thought there should be a cycle 6. My paraproteins are now very low at 2 so I replied that if I was being given a choice then I’d prefer not to go through another cycle. At the end of each cycle now it seems to take me longer to recover. I tend to have a few days at least following treatment where I feel pretty rough and I am always tired now. Rough is a bit non descript but I’m not sure how best to describe it. Just feeling shattered, nauseous and just generally not well (without vomiting). This week I’ve felt particularly rotten even though I’ve had a week off treatment. He agreed that having had consistent low para protein results then it was probably time to refer me to the transplant team for stage 2.

To my surprise the transplant team rang yesterday and asked me to go over for a meeting today. How’s that for service? I’ve read a lot about the next stage and discussed it with my consultant previously and if I’m honest have been a bit apprehensive about it. Having had my meeting today I feel a lot more at ease and am happy to take what comes next. A few weeks ago I posted a copy of the leaflet relating to High Dose Therapy in the resources section of this blog. I still recommend reading it as I have no medical knowledge or training at all however I thought I’d try to supply the basics in layman’s terms here.

As explained to me by the consultant I met today, High Dose treatment with stem cell support is not a new treatment and it’s not restricted to people on a cancer trial. It’s not for everyone but has been around for a long time. It’s often offered in order to consolidate treatment already given and because it is a treatment which is known to work. That doesn’t mean it cures things but, in my case, it should help to keep the myeloma at bay for a longer period of time.

Stem Cells

Probably the first thing to understand is what a stem cell is. In this context a stem cell is a juvenile cell that is generated in the bone marrow and goes on to become either a Red Blood Cell, Platelets or a White Blood cell. It’s possible to move the stem cells from the bone marrow into the blood stream where they can be collected. The reason they are collected is because the next stage includes having a high dose chemotherapy treatment called Melphalan. The Melphalan will target all cells including the “good” bone marrow so the stem cells are collected in order to re generate the bone marrow.

Melphalan is a high dose chemotherapy which I have been quite apprehensive about but having met the consultant today and been given some information about it am less worried. Yes there are still the risks that are associated with all chemotherapy but I’ve coped ok so far and provided I follow the hospitals advice I should be ok.

The stages

The Macmillan leaflet beaks the whole treatment into stages and it’s probably the best description I’ve seen to date so rather than re-invent the wheel will use their description.

Stage 1 – Preparing for the treatment.

This usually happens after several courses of chemotherapy. This is to get rid of the bulk of the cancer cells and to give the treatment the best chance of working.

The week before (starting 25th September) I’ll receive a week of G-CSF injections. G-CSF is a growth hormone produced naturally by the body but in this case has been replicated exactly and synthetically. Its used increase the number of stem cells and to move them from the bone marrow into the bloodstream.

Stage 2 – Collecting the stem cells

This is the harvest. It can take a couple of days. In my case I’ll go to the Freeman hospital on the 29th September in order to start this process. A blood test will initially be taken to check how the stem cells have mobilised. It’s likely to take a day but could go into the next day during which I’ll be hooked to a machine called a cell separator which uses a centrifuge to separate the stem cells, which are collected in a bag with the remaining blood being given back to me. In my case (because of my age) they will attempt to collect enough for two treatments, should they be needed at a later date.

Stage 3 – High Dose treatment

This is to get rid of the remaining cancer cells by the administration of the chemotherapy Melphalan. This will destroy the majority of the cells in the bone marrow. this is likely to take the day.

Stage 4 – Having the stem cells (transplant/graft)

The stem cells are returned to me via  a drip

Stage 5 – Waiting for the blood count to recover

This can take a number of weeks and will require medical support. I’ll spend some time in hospital for possible 2-4 weeks, maybe a little longer depending upon how things go.

Stage 6 – Recovery after a transplant

Once my blood count (the level of blood cells in my blood) has recovered I’ll be allowed to go home  with some advice regarding diet and lifestyle. The consultant I met today advised that recovery at this stage could be over 3-4 months with me feeling generally tired. All said and done I should be ready to start stage 6 around end of October beginning of November if things go as planned.

I strongly recommend you read the leaflets available to you and that you speak to your doctor/consultant. Don’t take anything I’ve put here as definitive for you as we are all different and even though we may both have the same diagnosis our treatment paths may vary. There is also a load of advice and information for you in the leaflets that I haven’t covered in this post.