Day +6 is another good day. Got more sleep last night. Finally I will get down to write about the treatment before the transplant. Today, I asked my Consultant if this procedure, stem cell transplant is a ‘cure’ or a way to ‘prolong life’. She looks at this as a way for a complete cure, but it is possible for the leukaemia to return. Which is probably the case for most cancer remissions.
Treatment starts on Day -10. They put in what is known as a Hickman Line on the day you enter. A Hickman line is an intravenous catheter used to administer the chemotherapy, other drugs and withdraw blood. This was done under a local anesthetic, I think by a surgeon, but it could have been a radiologist as it was done in the X-Ray department. It involved two cuts, one at the main vein that goes directly into your heart and one on the chest wall. It was not a painful procedure and probably took less than 30 minutes. They do warn you about the potential complications beforehand, such as bleeding or puncturing the lung. This went off smoothly without any complications which is the norm.
The first chemotherapy drug is Fludarabine and is given from day -10 for 6 days. It was an IV infusion (through the Hickman line) and took about 30 minutes. They do prepare you in advance by giving you anti-sickness drugs and I was able to handle this well. No side effects at all. I was able to go home for a few hours on Saturday, Sunday and Monday, have my home cooked meal and get back to hospital at night. This was a great break and if offered I would take it without hesitation. It was strange coming back to hospital that second night, but this is the only chance you get to go home for a long time.
The second chemotherapy drug starts on day -6 for 2 days. This is Busulfan and is given orally. At this point, you are on two drugs for chemotherapy and your blood counts are on their way down and you are now in an isolated controlled environment. The party is over! I was able to handle this drug well too.
The chemotherapy is a carpet bombing raid and destroys all the good and the bad cells. It is a preparation to accept to new healthy stem cells from the donor. Stem cells are the ‘mother of all cells’ and produce new cells in the body.
Day -4 is when they introduce you to ATG Fresenius (Rabbit) an immuno suppression drug. This is to switch off your immune system so that it will not reject the donor cells. This is developed using a rabbit serum and they warn you of potential bad side effects. In my case, I was scared and at my wits’ end fearing the worst. Before they administer the drug you get anti sickness tablets and steroids to counter any reaction to the ‘foreign’ serum. The first dose is given intravenously over 12 hours and the first six hours are when most of the side effects tend to lift its ugly head. I got away lightly with some sickness and a mild headache. You continue with this drug for the next three days, Days -3 to -1 over a slightly shorter duration of 10 hours. I continued to get mild headaches and lost my appetite but it got better as the days progressed.
Finally, Day Zero arrives and as preparation you are given another immuno suppression drug, Clorosporin. This is given intravenously as well over 6 hours. Clorosporin is given to keep the donor stem cells in check. One of the major problems with a transplant is Host-Graf disease. It is when your donor cells take over your system and start to reject not only the cancer, but also other organs of your body. More on this in another posting. You will be on Clorosporin for a long time, while in hospital it will be given intravenously and later on in tablet form. They will constantly monitor these levels in your blood stream. I used to get a bad headache with Clorosporin but after about two days it went away.
I have talked about the transplant in one of my previous postings. Tomorrow I will write about the Cancer Support Group. The focus is often on the patient only but the people around you need more support and this is often overlooked.
There is a patient in another room and she was very sick. I was in a negative pressure room and had to move out to allow her to move into my room. When you are reading this blog, PAUSE, and say a prayer for her.
Talk to you again tomorrow. God Bless!