Handmade With Love

Multiple myeloma can be treated posete dama by different chemotherapy regimens. One treatment, known as the Arkansas Treatment, includes an autologous stem cell transplant. “Autologous” means that they collect the patient’s own stem cells prior to the final cycle of chemotherapy. Then, they return these stem cells to the patient after the administration of a high dose of drugs during the final cycle of chemotherapy. Unlike bone marrow transplants or stem cell transplants that require matching of a donor’s marrow or stem cells to the patient’s, no matching is required with an autologous transplant. They collect the patient’s own stem cells which removes them from the body and from the effects of the high dose of cancer drugs. Because they have been collected, removed, and stored, the stem cells are not present in the body during the administration of the high dose drugs. When the high dose drugs are no longer a danger to good blood cells (usually about 48 hours later), the stem cells can be returned to the patient’s body where they can once again perform their normal functions and make new blood cells.

Following the week of chemotherapy of the third cycle (the planned timing for this procedure), the patient must report to the cancer clinic on a daily basis. Since the goal is to perform this whole procedure on an outpatient basis, the patient may be required to move into a hotel room close to the cancer clinic. This allows the patient to stay relatively isolated from other people during a time when their blood counts (and immune systems) are particularly low, and it allows the patient to live close to the clinic. It is very convenient, and usually much, much less expensive than an inpatient stay at the hospital.

The actual collection process usually takes place at a local hospital, but the preparatory steps can all be performed at an appropriate cancer clinic. All of the procedures discussed in this article are performed on an outpatient basis. Collection usually takes place during daylight hours in the hospital, so patients can return to their homes or to their hotel rooms at night.

For the Arkansas Treatment, chemotherapy cycles are usually scheduled about a month apart — it depends on the patient. In the Arkansas Treatment, the chemotherapy occurs over the course of a full week. During the second week, fluids are administered as needed, and an office visit is scheduled with the oncologist. The third and fourth weeks are planned to be recovery time for the patient before the next cycle begins.

When the doctors decide it is time to collect a patient’s stem cells, some changes will be made to the chemotherapy routine. The first week of chemo, when the various drugs are administered, remains the same. Depending on the chemotherapy drugs administered, portable pumps may be attached to the patient’s port to provide chemo 24 hours per day from Monday noon to Friday noon. Following that first week of the chemo cycle when stem cells are to be collected, the schedule is different. On the Monday of the second week, the patient usually must report to the cancer clinic (or the hospital) on a daily basis. During these visits, the nurses check blood counts (which will usually be quite low) and they administer shots of a drug that encourage the body’s production of stem cells. The drug they use to encourage the body to produce more stem cells also encourages the new cells to enter the blood stream. Shots of that drug are administered every day until collection has been completed.

During this second week, the patient may not spend much time at the clinic. The nurses will test the patient’s blood; provide appropriate fluids as needed; give the shots to encourage the production of stem cells; and send the patient back to their hotel room to rest. Remaining isolated in a hotel room minimizes chances of catching an infection from a sick person (which could easily happen in a hospital. ) This week may be spent with lots of lying around watching tv, sleeping, and doing mostly nothing.

Before the collection process, the white blood cell count has to rise past a certain threshold value, and then when the white count is OK, the number of stem cells in the blood stream also has to exceed another threshold value. They usually plan for collection to begin on the Tuesday of the third week of the chemo cycle. The day before collection is scheduled to begin, they will collect blood samples, and if the white cell count is good, they will collect an extra vial of blood. This extra vial will be sent to the local blood bank to count the number of stem cells present. If the count is sufficiently high, the patient will be directed to report the next morning at the designated collection room at the designated collection facility (usually a local hospital).

Upon arrival at the stem cell collection room early in the morning, the staff must first insert an appropriately sized central venous catheter. This usually takes place in an operating room and the insertion is performed by a physician. Following insertion of the catheter (a relatively brief procedure), the patient will be returned to the collection room and connected to a stem cell collection machine. They usually collect stem cells from early morning until about 3 P. M. If further collections are needed, they will continue the following day.

During stem cell collection, the patient will be confined to a bed in the collection room. The patient can eat, sleep, read, watch TV, listen to the radio, work on the computer, etc. The only requirement is that the patient remains in the immediate vicinity of the collection machine, which means the patient is usually confined to the bed. This usually makes for a comfortable, lazy day. Depending on how many stem cells are collected during that day, the patient may receive another shot to encourage the body to produce more stem cells, and be scheduled to return to the collection room the next morning. Collection can continue for 5 days, at which time the central venous catheter has to be removed. It is a temporary insertion — good for 5 days max. So it is possible that patients can spend five days in the collection room attached to the continuous centrifuge that separates the stem cells from the rest of the blood.

The machine used to collect the stem cells is a continuous centrifuge. Stem cells are small and light so they float and come to the top when spun in a centrifuge. This allows them to be easily separated and collected. The input line to the machine is connected to one lumen of the patient’s central venous catheter. After the blood passes through the continuous centrifuge and the stem cells are separated and collected, the remaining blood flows through a heater to warm it to the appropriate temperature and it is then returned to the patient through a second lumen on the central venous catheter.

At the end of the day, all stem cells collected are sent to the local blood bank where they are analyzed and counted, mixed with preservatives, and stored (frozen). The goal is usually to collect 10 million stem cells — enough for two transplants of 5 million each. Some patients only need to spend a single day having stem cells collected. Others spend the full five days collecting stem cells. It depends on the patient. Following collection of the stem cells, the central venous catheter will be removed, and the patient will be released to check out of the hotel and return home.

Experience has shown that the patient may spend a little over a week in a hotel room near the cancer clinic. It will be conveniently located and it will usually be a suite with two bedrooms in it so a caregiver can keep an eye on the patient. Since this is a relatively complicated procedure and the body must cooperate with several medications as well as produce large numbers of stem cells AND kick them out into the blood stream, there are lots of complications that can happen to drag out the collection process or to prevent it completely. The process described in this article is typical of the stem cell collection process that is part of the Arkansas Treatment for multiple myeloma. Each patient is different, but for this treatment process, this article describes the planned schedule of events and the planned set of results. Although actual results may differ, the events and processes just described are typical.

Dennis Dinger is a survivor of multiple myeloma. Diagnosed in June, 2008, he received five cycles of the Arkansas Treatment: four of chemotherapy, plus the fifth — the high dose and the autologous stem cell transplant. His book, My Bout with Multiple Myeloma, chronicles his battle – to include the year prior to diagnosis, the treatments, and the recuperation period following all treatments. Throughout 2010, the cancer was in complete remission. For more details on the book, click on My Bout.

In this book, he includes descriptions of most of the procedures to which he was subject, he gives helpful hints and suggestions to others who may have to deal with this or other cancers. The book was written for those who have been similarly diagnosed, as well as for their family members and friends who may be called upon to support their loved ones through similar battles.