March 10, 2012

what's a stem cell transplant look like

     Stem cell transplant (SCT) in it's entirety is a long and complex process which takes about 12 months in total to complete.  I'm not even going to try to go into all the details in this post.  I'll blog those as they come along.  The transplant itself, in contrast, is quite quick and pretty straightforward.  It's not like a surgery or anything.  Everyone can be in the room and watch. 

     The process leading up to the transplant varies according to the patient, the type of cancer and the type of transplant they receive.  It involves admission to the hospital for 1-2 weeks prior to the transplant where they will receive the chemo appropriate to them.  Gone are the days where they irradiate the person to knock out the bone marrow.  You can get much better success with lower doses of chemo.
     While the patient is doing their thing, a whole other process is being coordinated.  It's like cooking multiple dishes and having them all finish at exactly the same time.  Behind the scenes that we don't see is the stem cell collection.  We don't see it because my dad's was an unrelated donor.  All that we know is that he is a he and 37 years old.  He either gave the cells at an institution near his home or he was actually flown in to MD Anderson.  He would've gone through a battery of tests to insure he was in good health similar to the ones my uncle went through.  They were fresh stem cells, not frozen, and they were collected at about 2 pm the day before.  If out of town, they would've been flown in, probably by a medical courier like organ transplants.  The lab would've then cleaned them up and resuspended them in some new media.
     Because all that collection is happening somewhere else, we didn't actually know the time of the transplant.  We found out the morning of the transplant.  Originally it was scheduled at 1:15 pm which then was bumped up to 11:30 am.  I can't remember MDACC ever being ahead of schedule on something.  I think this was a first but what a day to be early. 
     The morning of the transplant the doctor walks in with his entourage of fellow, nurse, PA, and pharmacist.  He exams my dad briefly and assures us that everything is a green light.  My dad was given the premedications of steroids and benadryl to prevent any reaction.  At about 11:00 am, the nurse walked in with the cells while also teaching a nursing student (they have to learn on somebody, right?).  And here they are.  Only 284 milliliters.  A little more than a cup.  But, oh, but what's in that cup....big things in small packages and all that.

     My dad understandably wished to hold them.  He held them high, asked for the Lord's blessing and graciously thanked whomever donated them.

     The doc peaked his head in the door and gave his thumbs up.  The chaplain read a bible verse while the nurse began attaching the cells to his IV line.  The nurse remained in the room the entire time to make sure it goes off without a hitch.  The bag emptied by simple gravity and was done in less than 45 minutes.

Going, going, gone!

    That's all there is to it.  Amazingly quick for something that takes so much effort and timing.  The challenge is the stuff afterwards - like the urinary tract infection my dad had less than 24 hours later.  And I'll wager that there will be many more challenging days ahead.

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