Stem cells are in the bag… And I’m in remission!

Stem cells are in 4 bags actually — in a freezer. 8.99 Million Stem cells to be more precise, or we can just call it 9 Million since we’re all friends here. This is probably enough for 3–4 stem cell transplants, should I need them down the line.

We started the process on Friday, meeting with the transplant coordinator to go through the plan. I was shown how to give myself the Neupogen injections into my stomach to stimulate my bone marrow to pump out stem cells (and white blood cells and other stuff). Not a problem, actually. I had some experience after my surgeries where I had to inject a blood thinner into my stomach (Lovenox) which was much more painful. I was suprised that I’d have to do 3 of them per day, though, at around 8pm each day.

On Monday, I went in for labs early, and then across town to get my Quinton Catheter installed. They had me dress in hospital gowns, brought me into the operating room, and applied local anesthetic. They do this type of procedure in a radiology clinic, because they use sonographic and floroscopic images to make sure it’s inserted properly. (it was the same clinic that installed my chest port) The procedure took about 15 minutes. It was really uncomfortable, but it was mostly due to the dressing they put on it afterwards. They taped it up good, which limited my neck mobility. The catheter goes all the way to the heart, and it has two lines for input/output access.

While getting the catheter, I was told that the Neupogen had gotten my stem cell count up to 25/uL, which by their rule of thumb would have only yielded 2.5 Million stem cells harvested on day 1. That clearly wasn’t going to work, so they had me come back to the clinic for a shot of Plerixafor, which makes the bone marrow “push out” all of the stuff it’s been making. I also gave myself 3 more Neupogen shots when I got home. Monday night was bad. I had a stiff neck and bone aches (which meant the stuff was working).

We got up really early Tuesday morning to get the collection started. They took labs in the morning, and then hooked me up to the machine. We had a nice private room with a TV, but Rachel had an uncomfortable chair all day. While we were collecting, the labs came back showing my stem cell count at 128/uL (a 500% improvement — the Plerixafor clearly worked) which made us optimistic that we were going to reach our goal of 8 Million stem cells in just one day. Most people take at least two days to collect, and 4+ days in some cases. We were very happy to see 8.99 Million collected at the end of the day, which meant that they could take the Quinton Catheter out, which they did in about 5 minutes. We had to apply pressure for about 25 minutes to make sure it stopped bleeding. Fun fact, the machine cycled 18.5 liters of blood during the day — that means all of my blood went through the machine 3 times..

Just chillin, collecting stem cells like a boss

And now for the good news. We ran my monthly Myeloma panel. I don’t have any detectable cancer in my blood — I’m in remisson!

No M-Spike, highlighted in yellow
No bad guys in my blood
Light Chains look great

My IgGs are even back up near 600. (and none of them are cancerous) This, combined with my high white blood cell count from the Neupogen injections means that I actually have a functioning immune system right now.

When we ran the numbers last month showing an M-Spike of 0.1, I still had 2 weeks to go in my last chemo cycle. This means that the infusions and pills in those last two weeks got me over the line — I did like the EXACT AMOUNT of chemo necessary to get me into remission before the Stem Cell transplant. We really couldn’t have planned it any better. It also means that I’ve been in remission without any chemo for 3+ weeks (because we finished chemo on May 16)! Getting my immune system clobbered and being sick all that time was a small price to pay for this.

I am a bit anemic, however. My hemoglobin heading into the collection was 12, and low-normal is 13.6. After the collection it was 10.7. They give a blood transfusion when you get to around 8. I’m a bit lightheaded, and I’m not going to win any long (or short) distance races any time soon. I have some time to get this back up heading into the Stem Cell Transplant procedure, and I do expect it to go up given that I have no cancerous plasma competing with my bone marrow and that I’m not taking any chemo drugs right now.

This brings up an interesting question — If I’m in remission, why do I need to do a stem cell transplant? Because even if I’m in the highest classification of remission — sCR/MRD-negative (we’re not doing that test now because I just did a bone marrow biopsy last month), Myeloma almost always finds a way to come back. There are inevitably a small undetectable amount of those bastards hiding out in my body somewhere. We are sticking with the aggressive plan, which is stem cell transplant followed by long term/low dose maintenance chemo to keep it at bay. The fact that I’m in remission before the SCT does improve my prognosis.

The Stem Cell Transplant procedure starts on 6/21, but there are plenty of hospital visits in between now and then. If all goes well, I’ll get the Melphalan (the mustard gas chemo) on 6/21 in the evening, get my stem cells back on 6/23, and check into the hospital on 6/26 for 2–3 weeks. (they give me a few days where I can be at home before the chemo starts kicking my butt)