Stem Cell Transplant – February 27, 2019

Stem Cell Transplant

Today is the big day – the stem cell transplant. Stem cells collected back in December are reintroduced, or infused / transplanted, back to the body. The process isn’t a long or overly difficult one, but does involve some discomfort for the patient. Overall health going into the day was okay, but not great. A few days of being either nauseous or physically sick coupled with poor sleep. Lots of medication and drugs means Cindy is a bit down – but not out.

The transplant team consisted of 2 lab technicians, 1 care nurse, 1 infusion nurse practitioner, 1 primary nurse practitioner, 1 nurse practitioner intern, the oncologist. And of course Cindy but I guess she’s less a team member and more the main actor. The first step was a pre-game meeting about 11:00 with a great NP intern named Paige. She reviewed with us the process of the day and was available for any last minute questions. All things being a “go” we began the countdown.

The Setup

A 13:00 scheduled start time to the procedure meant the cavalry started to show up about 12:30. The first thing that happened was the nurse setup the room. With lots of people working, each in their own space with their own tasks, it means organization is critical. There is a real process and these folks are experienced and efficient. She got Cindy settled and after a quick last minute bathroom break, she was confined to the bed until the procedure was over.

The nurse then introduced the initial pre-meds via IV and took vital signs as other others filtered in with their various tools and devices. Next to show up were the lab techs – they bring with them a super cool (and super cold) lab transfer device used to move the cells from one place to another. Stem cells are stored in individual small packages at -188C and need to be kept there until used – cooled by liquid nitrogen. The techs got their stations setup and ready to go as the nurse got her station setup with cold water, vitals charting, and other miscellaneous thing “just in case”. The final person to arrive was the nurse practitioner who would do the actual transplant.

Transplant Process

The process of transplant follows this basic procedure. Pull an individual frozen stem cell package, verify contents, thaw, draw contents into a syringe, push syringe into body.

The lab techs are medically and physically responsible for the stem cells until they are about to be infused into the body. Techs first remove a frozen package from the transfer device. Cells are stored in metal envelope device with bar codes and such to make storage and management of them easier. The envelope is opened and the bag of cells removed, which are in another ziplock bag. I asked about the “ziplock” bags. These are NOT medical ziplock bags, just your run-of-the-mill grocery store ziplock bags and they buy them at Costco. Who knew, that Costco has everything!

The Thaw

Anyway, the package is again double-validated by two nurses to ensure they are the correct stem cells and are then removed from the not-so-medical ziplock bag and placed in a large bowl of warm water. The water thaws the cells rapidly while the tech massages them and I’m sure there is much more art and science behind what the tech was doing than I could interpret. This removal, verification, and thaw process takes about 3-5 minutes per package – the next package isn’t started until the previous process is fully complete.

The Infusion

From here, another tech takes the now thawed cells and, again validating their contents, draws the fluid into a massive syringe. The syringe contains 50-70ml of cells and when loaded is provided to the infusion nurse. The infusion nurse takes the syringe, inserts it into a line running into the chest apheresis line and begins the slow process of pushing them into the body. This takes a few minutes per syringe. It is unfortunately accompanied by a horrible garlic taste in the mouth, a bit of hot flashes, some sickness feeling, blood pressure dropping, and a few other patient side effects. The storage or preservative agent in the mixture causes most of the side effects and as soon as the pushing stops, almost immediately so do the side effects.

Managing taste is difficult and the care nurse provides very tart candies to suck on – these too are borrowed from a non-medical source. They appear to be more protected than most of the narcotics on the floor as we needed more and it took two nurses to deliver from a special office! The flashes of hot are managed with a cold towel on the head. Finally, the care nurse is monitoring vitals every couple of minutes to watch for problematic blood pressure drops or heart rates. The process starts over again once the syringe is fully injected.

Still Going

Cindy had 6 bags of cells to infuse, and each bag was large enough to require 2 syringes for a total of 12. Like clockwork, the process kicked off at roughly 13:15 and completed before 14:00.

There were some tough moments during the process, but overall Cindy was a champ. She never asked to stop and never really felt overly bad (although maybe she’d tell you something different). The entire process took less than 45 minutes. In unceremonious fashion, and with another transplant to do today, the team packs up. They say a quick goodbye and good luck, and are off. These are professionals through-and-through. They do this for a living and save countless lives – they don’t want or need gratitude and thanks for it. But they got it from us in spades. Thank you team – truly amazing!

Post Transplant

Immediately after the transplant the room is again empty and it’s basically time to sleep. This ends the formal treatment regimen for Cindy’s cancer. It’s all up to her body now to do the rest. Being very tired for the next few days is the normal course. Then she’ll be susceptible to illness as her immunities bottom out and flatline. Mid-next week is the earlier she’s considered for discharge and more likely end of next week. Please feel free to pass along any messages on whatever platform you have. For now, visiting is off limits until we see counts start to rise again. Thank you all for following along and more updates as we have them.

Pictures & Video

The Start

The Finish