Friday, August 5th, 2016
Mom arrived tonight, driving after work in anticipation of the start of my first round of chemotherapy tomorrow. I have to be at the hospital tomorrow morning for 11am. I will be admitted, and then the fun officially begins. The plan is to do one overnight in the hospital after chemo, and then home to rest and start the neupogen shots on Monday.
This seems like an appropriate time to discuss the whole crazy process that is about to start, and to answer questions like “what is neupogen?”
What is a hematopoietic stem-cell transplant (HSCT)?
Often times when someone says “stem-cells” people automatically think of cancer, and/or cell regeneration like the kind being studied for use in spinal cord injuries, and sometimes crazy science fiction experiments.
This is not the case in my situation. The goal of my stem-cell transplant process is to use very strong chemotherapy to kill the parts of my immune system that hold the ‘memory’ used to attack the myelin sheath around my nerves. By erasing this immune memory, the hope is that the auto-immune disease process will be halted.
Once my immune system is suppressed with the chemo, I will get a transfusion of my own stem-cells, helping the immune system to heal. These stem-cells will be collected prior to the depletion of my immune system, and stored until I’m ready to have them re-infused. Hence, the name “hematopoietic stem-cell transplantation” meaning “receiving a transplant of your own stem-cells.”
Does this have anything in common with the same treatment used for cancer?
The HSCT process is based on the procedure used to treat various forms of cancer. In the treatment of cancer, the goal is to kill the ENTIRE immune system including the bone marrow, where immune cells are produced. To this end, radiation AND chemotherapy are often used and patients often require a bone marrow transplant from a donor to survive.
The protocol used to treat CIDP varies in the level of toxicity. Some programs/institutions protocols’ target only the immune memory (sometimes called stem-cell transplant light) while the protocol used here in Ottawa is more thorough and toxic, in an attempt to not leave enough immune memory to replicate the disease after transplant but not so much as to kill the bone marrow.
What is the process?
At this junction, I will only try to explain the collection process part of the transplant procedure.
The first phase of the collection process will be one dose of chemotherapy called cyclophosphamide. I will experience many of the traditional side effects of chemotherapy, including hair loss. My blood counts will fall, and I will have to watch for signs of infection like fever, pain, and/or nausea. I will have to stay away from crowds, and definitely away from anyone who is already ill. This fall in my blood count will help to springboard the growth of stem-cells for the next part.
After the chemo, I will receive 10 days of subcutaneous neupogen injections at home (thanks for doing that mom!). The neupogen will stimulate the growth of the stem-cells found in my bone marrow, and cause them to push out into my peripheral blood. After this happens, these stem-cells will be collected in a way very similar to dialysis. I will be hooked up to a machine that draws the blood out of one arm, runs it through a machine to separate out the stem-cells, and then re-infuses it back into my body.